Nausea and Vomiting During Pregnancy

 

Nausea and vomiting, which begin between the 6-8th weeks of pregnancy, may affect the comfort of the woman in varying degrees during pregnancy. From time to time, there may be only hypersensitivity to odors, nausea and vomiting of varying severity, and sometimes too severe nausea can become a medical problem that may require hospitalization with vomiting.

Odor sensitivity, nausea or vomiting seen in mild form is a common physiological condition that can be seen in 50-80% of pregnant women and is inherent in pregnancy. It is usually intense in the morning and therefore referred to as ‘morning sickness’, but it can occur at any time of the day.

‘Hyperemesis gravidarum’, on the other hand, is a clinical condition with severe nausea vomiting, inability to meet the requirements of daily life, severe fluid loss, acid-base and electrolyte balance disorders, weight loss that expresses 5% and above body weight loss, and rare liver and kidney failure. . It is seen in 0.5-1% of pregnant women. Generally, a limited answer is received or not responding to outpatient treatment.

 

Reasons:

There are many theories about causes, but none have fully elucidated the cause and development of the problem.

The level of HCG (human chorionic gonadotropin) increases in multiple pregnancies due to the increase in the number or surface of the placenta. Abnormal change in placental cells in molar pregnancies is accompanied by an increase in HCG level. In both cases, hyperemesis gravidarum can be found more frequently and severely. However, severe nausea and vomiting can be seen with normal sensitivity of HCG. In other words, in severe nausea-vomiting, HCG level is not required to be high.

Pregnancy hormones, estrogen and progesterone, reduce stomach smooth muscle contraction and delay gastric emptying or disrupt post-meal stomach rhythm. Depending on this, nausea and vomiting may occur. However, as stated in HCG, progesterone and estrogen blood levels are not required to be higher than normal. The high level of personal sensitivity at normal hormone levels may also be the reason for the process.

Hyperthyroidism is observed temporarily in 2/3 of women with hyperemesis gravidarum. The hormone HCG acts on the same receptors as TSH, creating temporary hyperthyroidism during pregnancy and regresses spontaneously in the middle of the second trimester. Nausea and vomiting are frequent in this group. However, if the symptoms of hyperthyroidism such as palpitations and enlarged thyroid gland are very severe, detailed research should be done. Normally, treatment for transient hyperthyroidism is not recommended.

Disruption of the contraction rhythm of the gastrointestinal tract, especially the stomach, also delays gastric emptying and causes nausea. Increasing estrogen and progesterone levels can lead to this in pregnancy, but in women who have a lot of stomach problems, stomach emptying rhythm before pregnancy may be problematic. Helicobacter pylori infection, which is a cause of stomach problems, is one of the important causes of nausea and vomiting. In this infection, nausea and vomiting, digestive problems and pain can be added.

Psychological causes are also thought to be among the causes of nausea and vomiting. In this group, response to treatment can also be resistant and the feeling of helplessness felt by the woman may increase. If this possibility exists, it is recommended to seek help from a professional.

It is of course not possible for every nausea-vomiting problem to be related to pregnancy. If there is no response to treatment in very severe forms or weak, it will be appropriate to rule out other diseases in differential diagnosis. These are mole pregnancies, hepatitis (liver problems due to infection or other causes), cholelithiasis and cholecystitis (gallbladder inflammation and stones), pancreatitis (pancreatitis), gastritis or gastric ulcer, intestinal system obstructions, appendicitis, kidney stone, degenerated myomas, ovarian cyst torsion, diabetes onset, hyperthyroidism (overwork of the thyroid gland) and brain tumors. Many of these problems are rarely seen and often progress with other findings.

Diagnosis:

In diagnosis, ultrasonography should be done first. As the pregnancy week can be determined clearly, the possibility of multiple pregnancy or mole pregnancy is determined. The treatment approach is completely different in mole pregnancies.

After ultrasonography, the general condition of the woman is evaluated and system examinations are carried out.

The most important detail that determines the severity of hyperemesis gravidarum is laboratory evaluation. In the full urine test, acetone (ketone) is examined and the amount of ketone in the urine will increase as the severity of hunger increases. As the woman’s fluid loss increases, the urine density will increase. If fluid loss is severe, the amount of urine may decrease. Complete urinalysis and, if necessary, urinary culture and urinary tract infection are evaluated.

In blood tests, electrolytes in the blood are evaluated. In severe nausea and vomiting, sodium and potassium density may increase in the blood due to loss of fluid and if this condition has occurred, inpatient treatment is definitely recommended. In blood biochemistry, liver function tests and kidneys can be evaluated.

If necessary, gall bladder, kidneys and ovaries can be evaluated with all abdominal ultrasonography.

Treatment:

Mild forms of pregnancy nausea and vomiting do not require treatment. It is unnecessary to use nausea relievers if enough fluid can be taken. It will be appropriate to take the foods that can be taken frequently and in small amounts, to keep the products that can reduce stomach fluid such as crackers and biscuits ready, not to take liquids with meals and to consume the liquid as much as possible. The pregnant woman should never be pressured to eat and avoid the foods she abuses. Foods that can cause digestive disorders should be avoided.

If nausea affects a woman’s life before vomiting is too intense, or if nausea begins to increase, nausea medication options may be considered.

In severe forms of vomiting, it will be appropriate to perform fluid-electrolyte treatment by hospitalization.

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