What is Extreme Pregnancy Disease?
Extreme pregnancy sickness, hyperemesis pregnancy room, is a condition characterized by severe nausea and vomiting that affect the general condition. The vomiting can cause fluid and electrolyte disturbances (changes in the concentration of salts in the blood), which explains the general impact.
A commonly used definition is severe nausea and vomiting before the 20th week of pregnancy – which leads to more than 5% weight loss compared to pre-pregnancy weight, urinary ketones, dehydration and fluid and electrolyte disorders. The extreme nausea generally improves during pregnancy.
Hyperemesis gravidarum was previously associated with severe morbidity and sometimes deaths in the mother. Proper fluid supply and nutrition directly into the bloodstream mean that the morbidity is now much lower and the mortality rate is close to zero.
Nausea affects approximately 70-85% of all pregnant women to varying degrees at the beginning of pregnancy (usually onset in the fourth to seventh weeks). About half have vomiting. 0.1–1% of pregnant women need hospital care for nausea or vomiting.
Hyperemesis pregnancy room affects 0.3–3% of all pregnant women; another source sets the rate to 3.5 per 1,000 births. According to one study, hyperemesis occurred more frequently in women with girl fetuses than those with boy fetuses.
Most people experience nausea throughout the day, not just in the morning. The trouble usually starts between the fourth and tenth week of pregnancy. Nausea and vomiting are so pronounced that the general condition is affected. The patient is unable to get food or drink, and can become excruciating (more than 5% of body weight) and dehydrated.
Nausea usually reaches a peak around week nine of pregnancy. The condition can be so pronounced that it requires hospital care. Hospitalization reaches a peak around the ninth week of pregnancy, then decreases until pregnancy week 20, after which the condition is unusual.
The cause is unknown. Hormonal changes, enzyme effects, psychological explanations are believed to be important.
Hormones. The condition is undoubtedly caused by pregnancy hormones, but there is no safe explanation for the disease. No unilateral hormonal profile can predict predicted hyperemesis pregnancy. Estrogen and progesterone have long been linked to the discomfort. However, this is not true that these sex hormones have the highest level during the third trimester, usually after the symptoms of nausea have subsided.
Psychological explanations are related to the major physical changes during pregnancy, or that the disorders are caused by stress. In particular, ambivalent feelings associated with pregnancy appear to be associated with nausea. No studies can provide a consistent psychological profile of women experiencing hyperemesis in pregnancy, but psychological reactions to the nausea appear to exacerbate the symptoms.
Heritage. Women have triple the risk of extreme pregnancy sickness if the mother has also had this in one or more of her pregnancies. There is limited knowledge of whether extreme pregnancy sickness is due to environmental or hereditary factors. The absolute risk is still small. In one study, researchers found that daughters born after pregnancies with extreme pregnancy sickness had a 3% risk of developing the disease in their own pregnancies. This compares with a 1.1% risk in women born after an uncomplicated pregnancy.
Studies show that hyperemesis pregnancy is associated with teenage pregnancy, firstborns, obesity, multiple pregnancies (ie one pregnancy involving more than one fetus), trophoblastic disease (ie a cancerous tumor in the uterine mucosa), previous hyperemesis, reduced risk of miscarriage female fetuses. There are major cultural differences in the incidence of hyperemesis and the incidence goes down in wartime.
Pregnant women who react with nausea and vomiting to estrogen supplements, women who easily become car / car sick, have migraines or who respond more strongly than expected to taste, are at greater risk of pregnancy sickness and hyperemesis.
The diagnosis is usually based on the typical disease history, but other diseases must be excluded. In the medical examination, special emphasis is placed on evaluating weight loss, fetal growth and looking for signs of dehydration. Blood tests can show if the kidneys and liver are affected. The urine is examined for ketones. Ultrasound is made to determine if there may be multiple birth or trophoblastic disease (molar pregnancy).
The overall goal is to carry out the pregnancy with the least possible discomfort for the mother and the minimum possible risk to the baby.
Dietary Changes. Avoiding factors that trigger nausea is the most important thing. Heavy air, strong odors, heat, high humidity, loud noises, moving lights or self-driving (driving a car) are examples of this.
The pregnant woman should eat small dense meals, where the first meal should be taken in bed. She should preferably eat something before she gets hungry, as an empty stomach aggravates the nausea with food intake.
Some women seem to be less bothered by foods that are a little spicy, salty foods and meals that are rich in protein. Avoid foods that trigger or exacerbate nausea. Low fat foods have a shorter transit time through the stomach, and can therefore be beneficial. Take multivitamin from the time of conception, it reduces the intensity of nausea. Liquid seems to be better tolerated if it is cold, clear, with carbonic acid (or acidic beverages), especially if the intake is in small portions between meals.
Drug. According to a systematic review published in the medical journal Jama (2016), which looked at various treatment options for hyperemesis in pregnancy and nausea and vomiting in pregnancy, the quality of the studies available is generally low. It seems that the drug ondansetron (antiemetic) has a soothing effect (can only be given after the first trimester) and that cortisone can help in severe cases. For moderate symptoms, pyridoxine (B6), promethazine (neuroleptics and antihistamine) and metoclopramide (antiemetics) have proven to be more effective than placebo. For mild symptoms, ginger, pyridoxine (B6), antihistamines and metoclopramide have been shown to have better effects than placebo.
Intravenous fluid supply, possibly with added nutrients and vitamins, is very important in the treatment of inpatient patients with hyperemesis gravidarum. Probe can be used as an alternative. Unfortunately, intravenous fluid supply has no influence on the nausea. Addition of vitamins is important. The body’s supply of water-soluble vitamins is quickly depleted and these vitamins must be added.
Hyperemesis improves later in pregnancy, but complaints of nausea are experienced by 15-20% of pregnant women also in the third trimester, and 5% suffer from nausea until birth.
Nausea and vomiting have not been shown to have harmful effects on the child, but the condition can affect the quality of life for pregnant women. The permit has consequences for daily activities, both in private and in professional life. Studies show that the risk that subsequent pregnancies are also complicated by hyperemesis is 15-20% in women with a previous history of the condition. This while the risk for women without a history of hyperemesis is 0.7%.