Hyperemesis gravidarum is severe nausea and vomiting during pregnancy that lasts for more than a few days.
Many pregnant women feel sick (nausea) and, or may vomit during early pregnancy. This can vary from mild to moderate and still be considered part of the normal experience of pregnancy. People used to call this “morning sickness” but we now refer to it as nausea and vomiting in pregnancy, or NVP.
In mild and moderate NVP women are still able to eat and drink. Around 7 in 10 pregnant women will experience NVP, but they usually feel better after the first trimester.
When nausea and vomiting become severe, lasting for more than a few days, women will find it hard to eat or drink enough. This severe NVP is called hyperemesis gravidarum (HG). Around 1 in 100 pregnant women will experience HG, although this number may be higher. It may lead to dehydration (lack of fluid in the body) and cause weight loss and vitamin deficiencies.
HG usually starts early in pregnancy, before women are 16 weeks pregnant. For most women, HG stops between 13 to 20 weeks, while a few women have HG their entire pregnancy.
HG can have a big impact on women’s emotional, mental and physical health. Women are often so sick they cannot go to work, care for themselves or anyone else, and have great difficulty participating in normal daily activities.
HG can make women feel very unwell and needs to be taken seriously by their health care provider, families and support people and employers.
If you are suffering from NVP or think you may have HG, you should see your pregnancy care provider, such as your midwife, family doctor or obstetrician. If you are feeling very unwell you should go to the Emergency Department at your local hospital for advice and help.
Symptoms of nausea and vomiting can become harder to control the longer you are suffering. We encourage you to see your pregnancy care provider as soon as possible when you feel that:
Unfortunately, HG is often not always recognised quickly, so don’t be afraid to ask any questions about your health during pregnancy.
MotherSafe is a free telephone service for the women of NSW that can provide counselling and advice on medications to manage nausea and vomiting in pregnancy.
Call 1800 647 848 or search ‘MotherSafe NSW’ for more information.
If you are experiencing nausea and or vomiting, which is interrupting your ability to drink and eat, you should speak to your health care provider. They may ask you questions about how you have been feeling over the past 24 hours. The “PUQE-24” scoring system below shows how they will rate your responses, to understand how severe your nausea and or vomiting has been.
If your PUQE-24 score is:
HG is a real and debilitating medical condition, and it is important that you are listened to and get the treatment you need.
Based on your responses to the questions, your health care provider will suggest how to manage your sickness. If you have mild or moderate feelings of nausea and vomiting you do not usually need any other tests, however you may be offered some treatment for your symptoms.
If you have severe NVP or HG, your pregnancy care provider should do further tests, such as blood or urine tests. These tests will look for the cause of your nausea and vomiting and see how dehydrated you are. The results of the tests will help guide your treatment.
The first thing to know is that nothing you do or have done has caused HG. It’s not you or your partner’s fault and it does not mean there is anything wrong with your baby or your pregnancy. The exact cause of HG is not known but there are current studies on what the causes may be. So far we know that HG can occur more in some families. If you had severe sickness and vomiting in a previous pregnancy, you may be more likely to experience it again in later pregnancies. It seems to occur more when women have twins or triplets, however it definitely affects women who are pregnant with one baby too.
There is a lot of help available to ease your symptoms during pregnancy. Your pregnancy care provider will develop a treatment plan with you based on your symptoms and their severity. Sometimes the nausea and vomiting cannot be stopped completely. The aim of treatment is to reduce your symptoms enough to allow normal daily activities, especially eating and drinking.
If you have mild or moderate NVP, your health care provider may suggest:
If you have severe NVP/HG, or you are dehydrated, your health care provider may suggest:
*Some women need to be seen at the hospital or Day Stay hospital facility (or hospital in the home) to be given IV fluids. You may need to be admitted (stay in) hospital if you do not respond to medication, you are losing weight or can’t keep enough fluid down and become dehydrated.
Anti-sickness (antiemetic) medicine may be needed if your symptoms are not going away and are severe. You may be worried about taking medicines while you are pregnant. The medicines that health professionals recommend are considered safe and have been used for many years to treat nausea and vomiting in pregnancy. For some women, medication may be needed for several weeks or even months until symptoms settle.
Never take any medication without discussing it with your GP, obstetrician, community pharmacist or midwife. You can also call MotherSafe to get more information about medications.
Your baby gets its food from your body even though you may not be eating much when feeling nauseous or vomiting. If you become dehydrated it could affect your baby so it’s important you receive treatment and fluids. Some babies of women with HG may have a low birth weight when born. However, not all babies born to women with HG have a low birth weight.
Disclaimer: The following video shows women talking about their experience with HG, some viewers may find this upsetting. For help with pregnancy sickness call MotherSafe on 1800 647 848.
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