Nausea and Vomiting in Pregnancy -Hyperemesis Gravidarum

Nausea and Vomiting in Pregnancy is defined as symptoms of nausea, vomiting and/or dry-retching commencing in the first trimester without another cause. This often resolves after the first trimester.
Hyperemesis Gravidarum is defined as: 

• An early onset of symptoms before 16 weeks gestation
• Characterized by severe nausea and or vomiting
• Inability to eat and or drink normally
• Strongly limits daily activities

GET THE FACTS 

If you suspect you have hyperemesis gravidarum, make an appointment to see your care provider as soon as possible. At your appointment they will assess you utilising the PUQE-24 tool. You may also require further testing to exclude other possible causes of nausea and vomiting. 
If you are diagnosed with hyperemesis gravidarum, your care provider will create an individualised care plan to treat and alleviate your symptoms. This could include a combination of lifestyle changes and medications. It is important to note that your care plan may need to be changed and updated if you are not experiencing any relief. If this happens, call your care provider.

At each visit your care provider should ask whether you are experiencing nausea and vomiting between 4-16 weeks gestation. If nausea and vomiting is present, your care provider will use the Mother Risk Pregnancy Unique Quantification of Emesis (PUQE-24) score tool to classify your severity of symptoms, including weight loss and hydration status.

PUQE-24 score tool is a validated scoring system to classify the severity of nausea and vomiting in pregnancy. It assesses the severity of nausea and vomiting over a 24 hour period, with three questions relating to duration of nausea, frequency of vomiting and dry retching symptoms. An additional question considers overall wellbeing in the previous 24 hours.

Treatment options and advice will be based on your symptoms. Your care provider should provide a management plan for you to help you manage your symptoms. 
The management plan may outline a number of other clinicians to support your continuous care. The management plan will include advice on how to adjust care if symptoms improve, fluctuate or deteriorate and how to access care if required.

Click here to see a care plan. You can start to fill out for discussion with your care provider.

Treatment that does not include medication may be recommended. These may include: 

• modifying activity to gain more rest or bringing forward bedtime
• changing dietary habits to maintain hydration and nutrition (i.e. small amounts of well-tolerated food)
• oral ginger and/or vitamin B6
• acupressure bands
• avoid iron-containing preparations
• support from friends, family or community

The use of medication will need to be discussed with your care provider. If you are suffering from dehydration and electrolyte imbalance your care provider may consider the use of intravenous fluids. Intravenous fluid and electrolyte replacement are an effective treatment for dehydration, electrolyte imbalance and nausea and vomiting. These may be administered during a hospital stay or at a clinic. All treatment options and advice need to be based on your individual symptoms and severity. 

Below is a list of external organisations that can help when you are trying to navigate hyperemesis gravidarum. You may like to have family and friends check them out so they can have a bit more understanding of what you are going through.

Complications of uncontrolled hyperemesis gravidarum can include:

• malnutrition and loss of muscle mass, women with hyperemesis will frequently lose at least 5% of their pre pregnancy weight
• constant vomiting can result in tears to your lower oesophagus
• abnormally low sodium or potassium in the blood stream
• blood clots
• abnormal thyroid and liver function
• placental dysfunction associated with an increased risk of small for gestational age babies or preterm birth, preeclampsia and an increased risk of the placenta separating from the wall of the uterus before birth.
• dehydration and renal failure
• haemorrhoids
• alterations in mental health status and impact on the family unit
• dental enamel erosion see attached brochure on maintain good oral health hygiene. Many women will want to freshen their mouths following vomiting however the constant brushing can damage the enamel

Watch Keep Smiling You Are Pregnant 

Keep Smiling While You Are Pregnant English	Healthy Smiles For Aboriginal Women	Keep Smiling While You Are Pregnant Arabic, Chinese, Khmer, Vietnamese

Nausea and vomiting in pregnancy or hyperemesis gravidarum can impact your psychological and emotional wellbeing as well as that of the family unit. Women who experience these conditions are more likely to describe high levels of post-traumatic stress syndrome and associated negative outcomes.
It is recommended that postnatal care plans are developed with you during pregnancy. This will include your care moving from maternity post birth to community-based services, such as Child and Family Health services and your GP. For Aboriginal families refer to Aboriginal Child and Family Health services.

Your baby may be affected if you become very ill with untreated dehydration. If this happens your baby may be born with a low birth weight. However, not all babies born to women with hyperemesis gravidarum have a low birth weight.

If you have experienced hyperemesis gravidarum in pregnancy, for any future pregnancies it is recommended that you seek pre conception support, counselling and early or pre-emptive treatment with for nausea and vomiting.
There is a high risk of recurrence of nausea and vomiting in pregnancy and hyperemesis gravidarumin subsequent pregnancies. Subsequent pregnancies should be seen as early as possible in the first trimester.

Having hyperemesis gravidarumin can feel extremely lonely especially when those closest to you don’t really understand what’s going on. Below are some of the mistruths people may say to you, but it’s really important that you focus on the facts. A table of the differences in which morning sickness and hyperemesis gravidarum affect women is provided for reference.

MYTHS

• Hyperemesis gravidarumin is the same as morning sickness.
• You’re making a big deal out of nothing.
• My mum vomited when she was pregnant and she’s fine.
• It can’t be that bad.
• You’re weak. You just need to toughen up.

FACTS

Hyperemesis gravidarum is a significant debilitating illness affecting both the physical and mental aspects of women’s lives. If you get anything out of this website it should be to feel validated you don’t have to try and just carry on, what you are going through is incredibly hard, you are entitled to supportive care and treatment.

Professional interpreters are available if you need help to communicate with staff. Please ask our team who can make this booking for you. The service is free and confidential.