Hyperemesis Gravidarum: More than just Morning Sickness

As the news has broken that the Duchess of Cambridge (or the Countess of Strathearn as she is known in Scotland) is pregnant with her third child she is yet again being treated for Hyperemesis Gravidarum (HG).

As noted in the news, they often refer to HG as 'extreme morning sickness' however it is far more complicated than that. As a student midwife you learn about HG in your pregnancy complications classes - so not exactly classed as a usual side effect of pregnancy.

So what is Hyperemesis Gravidarum or HG. HG is diagnosed by ruling out other pregnancy related complications such as UTI's or increased thyroid levels.

Signs and symptoms often include:
Vomiting more than 3x a day, all day
Nausea
Fainting
Weight loss +5% of body weight
Ketoneuria
Dehydration
Reduction in Vitamin B1, B6, B12 levels

Reasons are often unknown but women are at a higher risk if they have experienced HG in a previous pregnancy, have a family history of HG, are obese, it is their first baby or they are carrying twins or triplets.

HG is usually treated by dietary control - eating bland foods and drinking electrolyte replacement drinks such as Lucozade sport.
Many women however will need hospitalisation, with a IV Fluid regime and anti-emetics.

HG is not just 'extreme morning sickness' - for a start HG occurs all day, throughout the entire pregnancy. HG can be debilitating, reducing woman's energy levels by affecting how much she consumes for fear of vomiting and can effect mood. Time off work should be sort by women suffering from HG to help maintain healthy energy levels for the mother and baby.
HG affects between 0.3-2% of pregnant women.

The effects on the fetus for women with HG can be increased risk of low birth weight, and small for gestational age baby and potential to be born before 37 weeks gestation.

So if you have a mother coming to you antenatally complaining of continued sickness and feeling faint, has a small or low diet and ketones in her urine - guidelines state she should be managed in the community with anti-emetics first before admission to hospital for monitoring and an IV fluid regime (RCOG 2016)

And don't believe the old wives tale that 'morning sickness is a good sign' and 'it means you're having a boy!'.
Hopefully with the media attraction to Kate Middleton more information on HG will be widespread in the community and women suffering from HG can seek advice and support.

Here are some support lines:
1. Call your midwife!
2. Pregnancy Sickness Support 
3. NHS Choices - HG


How much have you read on complications on pregnancy? Or have you met anyone with HG?
Tweet me @ruth_stmw

Ruth x

Infographics to go with blog can be found at http://sagefeminist.blogspot.co.uk/p/infographics-from-blogposts.html