He watched me anxiously at the foot of the bed while I set up an intravenous drip on the arm of his wife M, who was at her 8 weeks of gestation. She had been experiencing nausea with occasional vomiting for the past two weeks, being worse in the mornings. The symptoms had gradually worsened and she had been vomiting after almost every meal for the past 2 days.
“Doc, we thought it was quite common to have morning sickness," he said. I could sense that he felt sorry for not asking her to seek medical attention earlier. “Doc, will the baby be alright?“ he whispered, looking worried.
M was severely dehydrated on admission. I had to infuse 2 pints of isotonic fluid to correct her fluid and electrolyte imbalance. Fortunately, ultrasound examination of the womb revealed that her baby’s heart beat was still present.
M was suffering from hyperemesis gravidarum, a severe form of protracted nausea and vomiting during pregnancy. The exact cause of this condition is not known. It is believed to be due to the rapidly rising blood levels of pregnancy hormone, human chorionic gonadotropin (HCG) released by the placenta.
Hyperemesis gravidarum is not common, occurring in 1 to 3% of pregnancies. It can affect any pregnancy and is more common in patients with multiple pregnancy.
Besides severe nausea and vomiting, other symptoms include
· Weight loss of more than 5% of body weight
· Dehydration resulting in patient passing dark urine, having dry skin, weakness, or fainting
· Vomiting blood.
Besides intravenous fluid, M was also given anti-vomiting medications, vitamins and nutrients through the drip. Blood levels of electrolytes were checked every day. Medications were also given to prevent reflux and inflammation of the gullet (oesophagus) and stomach.
She responded very well to the treatment and was discharged home well after 5 days in the hospital.
However, I warned her that the nausea and vomiting might return She was advised to have adequate rest and to eat many small meals instead of one large meal. I also advised her to take a small amount of dry snacks between meals and to drink plenty of water in small quantities each time to avoid dehydration.
I encouraged her to include some ginger in her cooking as this may relieve her symptoms. Her food should be bland with very little oil and spices. I also prescribed acupressure wrist bands for her to wear in addition to the anti-vomiting medications.
With encouragement and support from her husband, M reported only occasional vomiting bouts during her subsequent reviews. She is now in her second trimester and the symptoms have since gone.