VOMITING AND MORNING SICKNESS IN EARLY PREGNANCY

What is nausea and vomiting of pregnancy?

Nausea and vomiting is a symptom of pregnancy and affects most women to some degree. It begins early in pregnancy, most commonly between the 4th and 7th week. It usually settles by 12–14 weeks and in severe cases, vomiting can last up to 20 weeks. Occasionally, it can last until the end of pregnancy.

It is often called ‘morning sickness’ but it can occur at any time of the day or night. The cause is thought to be pregnancy hormones but it is unclear why some women get it worse than others.

There is a chance of developing a severe form of pregnancy sickness called hyperemesis gravidarum. This can be serious, and there's a chance you may not get enough fluids in your body (dehydration) or not get enough nutrients from your diet (malnourishment). You may need to see the doctor in the hospital.

What are other reasons for vomiting in early pregnancy?It is important that other causes of vomiting are considered and looked into, particularly if you are unwell, have pain in your tummy or your vomiting only starts after 10 weeks of pregnancy. Possible other causes include gastritis (inflammation of the stomach), a kidney infection, appendicitis or gastroenteritis.

Who are at more risk factors for morning sickness?

It's thought hormonal changes in the first 12 weeks of pregnancy are probably one of the causes of morning sickness.But you may be more at risk of it if:

• you're having twins or more
• you had severe sickness and vomiting in a previous pregnancy
• you tend to get motion sickness (for example, car sick)
• you have a history of migraine headaches
• morning sickness runs in the family
• It is's your first pregnancy
• you're obese (your BMI is 30 or more)
• you're experiencing stress

 

When do you need to see the doctor?

Need to see a doctor urgently, if you are having vomiting and have very dark-coloured urine or have not had a pee in more than 8 hours, are unable to keep food or fluids down for 24 hours, feel severely weak, dizzy or faint when standing up, have tummy (abdominal) pain, have a high temperature, vomit blood and have lost weight.

Is there a definite treatment for morning sickness?

Unfortunately, there is no permanent solution for this problem as this happens due to the rising pregnancy hormone (serum B HCG) in the first 3 months of pregnancy. The severity of vomiting sensation and vomiting is different in every women and in every pregnancy.It can start from 4 weeks of pregnancy and is more between 8 and 12 weeks of pregnancy. It should come down by 14 weeks and rarely some women may continue to have symptoms throughout the pregnancy.

But there are some changes you can make to your diet and daily life to try to ease the symptoms.If these do not work for you or you're having more severe symptoms, doctor might recommend medicine.

What can be done at home to try and reduce vomiting?

If your morning sickness is not too bad, you can try some lifestyle changes:

• get plenty of rest (tiredness can make nausea worse)
• avoid foods or smells that make you feel sick
• eat something like dry toast or a plain biscuit before you get out of bed
• eat small, frequent meals of plain foods that are high in carbohydrate and low in fat (such as potato, bread, biscuit, rice and pasta)
• eat cold foods rather than hot ones if the smell of hot meals makes you feel sick
• drink plenty of fluids, such as water (sipping them little and often may help prevent vomiting)
• eat foods or drinks containing ginger – there's some evidence ginger may help reduce nausea and vomiting (check with your pharmacist before taking ginger supplements during pregnancy)

How will it make me feel? Nausea and vomiting of pregnancy can be a difficult problem to cope with. It can affect your mood, your work, your home situation and your ability to care for your family. Support from family and friends can help.

Will it harm my baby? There is no evidence that nausea and vomiting has a harmful effect on your baby. In fact, you have a slightly lower risk of miscarriage. Women with severe nausea and vomiting or with hyperemesis gravidarum may, however, have a baby with a lower than expected birthweight. You may be offered scans to monitor the growth of your baby.

Will I need to be admitted to hospital? Admission to hospital may be advised if youare dehydrated and having ketones in your urine is a sign of dehydration, have severe vomiting and are unable to tolerate any fluids, have abnormal blood tests, have lost weight, have a medical condition such as a heart or kidney problem or diabetes.

What happens in hospital? You will be given the fluids you need though a drip in your arm. This will be continued until you are able to drink fluids without vomiting. Each day your fluid intake and how much urine you are passing will be recorded. Your temperature, blood pressure, pulse, respiratory rate and weight will also be recorded.

What medications will be given for excessive vomiting?You should be offered anti-sickness medication and a B6 vitamin called thiamine; both of these can be given through the drip in your arm if you are unable to keep tablets down, graduated elastic compression stockings to help prevent blood clots, heparin injections (to thin your blood).

If you are taking iron medication, this will be stopped because it can make sickness worse. When you are feeling better, you can start to drink and eat small amounts and slowly build up to a normal diet.

What anti-sickness medication will I be offered? There are a variety of anti-sickness medicines that you may be offered. Not all of the medicines are licensed for use in pregnancy, but there is no evidence that they are harmful to your baby. It is worth considering taking them if other measures have not helped.

SUMMARY:

Nausea and vomiting of pregnancy is a common condition that usually settles by 12–14 weeks of pregnancy.

Nausea and vomiting and hyperemesis gravidarum can affect your mood, your work, your home situation and your ability to care for your family. Extra support from family, friends and doctor and nurses can help you. 

While most women can be treated at home or as outpatients in hospitals, some may need admission to hospital for treatment.

Hyperemesis gravidarum is a severe form of this condition and can affect up to 1 to 3 in 100 pregnant women

A variety of anti-sickness medicines are available that may help your symptoms. While some of these medicines may not be licensed for use in pregnancy, there is no evidence that they are harmful to your baby.