Hyperemesis gravidarum is extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, and electrolyte imbalances. Morning sickness is mild nausea and vomiting that occurs in early pregnancy.
Most women have some nausea or vomiting (morning sickness), particularly during the first 3 months of pregnancy. The exact cause of nausea and vomiting during pregnancy is not known. However, it is believed to be caused by a rapidly rising blood level of a hormone called human chorionic gonadotropin (HCG). HCG is released by the placenta. Mild morning sickness is common. Hyperemesis gravidarium is less common and more severe.
Women with hyperemesis gravidarum have extreme nausea and vomiting during pregnancy. It can cause a weight loss of more than 5% of body weight. The condition can happen in any pregnancy, but is a little more likely if you are pregnant with twins (or more babies), or if you have a hydatidiform mole. Women are at higher risk for hyperemesis if they have had the problem in previous pregnancies or are prone to motion sickness.
Morning sickness can cause decreased appetite, low level nausea, or vomiting. This is different from true hyperemesis because people are typically still able to eat and drink fluids some of the time.
Symptoms of hyperemesis gravidarum are much more severe. They may include:
Severe, persistent nausea and vomiting during pregnancy
Salivating a lot more than normal
Signs of dehydration, such as dark urine, dry skin, weakness, lightheadedness, or fainting
Inability to take in adequate amounts of fluid or nutrition
Exams and Tests
Your health care provider will do a physical exam. Your blood pressure may be low. Your pulse may be high.
The following laboratory tests will be done to check for signs of dehydration:
Complete blood count
Your provider may need to run tests to make sure you do not have liver and gastrointestinal problems.
A pregnancy ultrasound will be done to see if you are carrying twins or more babies. Ultrasound also checks for a hydatidiform mole.
Morning sickness can most often be managed by avoiding foods that trigger the problem and drinking plenty of fluids when the symptoms decrease in order to stay hydrated.
If your nausea and vomiting causes you to become dehydrated, you will receive fluids through an IV. You also may be given anti-nausea medicine. If nausea and vomiting is so severe that you and your baby might be in danger, you will be admitted to the hospital for treatment. If you can't eat enough to get the nutrients you and your baby need, you may get extra nutrients either through an IV or a tube placed into your stomach.
To help manage symptoms at home, try these tips.
Avoid triggers. You may notice that certain things can trigger nausea and vomiting. These may include:
Certain noises and sounds, even the radio or TV
Bright or blinking lights
Smells, such as perfume and scented bathing and grooming products
Pressure on your stomach (wear loose-fitting clothes)
Riding in a car
Eat and drink when you are able. Take advantage of the times you feel better to eat and drink. Eat small, frequent meals. Try dry, bland foods such as crackers or potatoes. Try eating any foods that appeal to you. See if you can tolerate nutritious smoothies with fruits or vegetables.
Increase fluids during times of the day when you feel least nauseated. Seltzer, ginger ale, or other sparkling drinks may help. You can also try using low-dose ginger supplements or acupressure wrist bands to ease symptoms.
Vitamin B6 (no more than 100 mg daily) has been shown to decrease nausea in early pregnancy. Ask your provider if this vitamin might help you. Another medicine called doxylamine (Unisom) has been shown to be very effective and safe when combined with Vitamin B6 for nausea in pregnancy. You can buy this medicine without a prescription.
Morning sickness typically is mild, but persistent. It can begin between 4 and 8 weeks of pregnancy. It typically goes away by 16 to 18 weeks of pregnancy. Severe nausea and vomiting may also start between 4 and 8 weeks of pregnancy and often goes away by weeks 14 to 16. Some women will continue to have nausea and vomiting for their entire pregnancy. With proper identification of symptoms and careful follow-up, serious complications for the baby or mother are rare.
Severe vomiting is harmful because it leads to dehydration and poor weight gain during pregnancy. Rarely, a woman may have bleeding in her esophagus or other serious problems from constant vomiting.
The condition can make it difficult to continue to work or take care of yourself. It can cause anxiety and depression in some women that lingers after the pregnancy.
When to Contact a Medical Professional
Contact your provider if you are pregnant and have severe nausea and vomiting or if you have any of the following symptoms:
Signs of dehydration.
Unable to tolerate any fluids for over 12 hours.
Lightheadedness or dizziness.
Blood in the vomit.
Weight loss of more than 5 pounds or 2.7 kilograms. (Weigh yourself several times to watch for excessive weight loss.)
Cappell MS. Gastrointestinal disorders during pregnancy. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 48.
Gordon A, Love A. Nausea and vomiting in pregnancy. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 54.
Kelly TF, Savides TJ. Gastrointestinal disease in pregnancy. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 63.
Mehra S, Reinus JF. Gastrointestinal and hepatic disorders in the pregnant patient. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 40.
Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.
Last reviewed on: 1/1/2021
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Severe Morning Sickness (Hyperemesis Gravidarum) (for Parents)
What's Morning Sickness?
During the first trimester of pregnancy, many women have the bouts of nausea and vomiting known as morning sickness.
Despite its name, morning sickness can happen day or night. It usually starts around the 6th week of pregnancy, is at its worst around week 9, and stops by weeks 16 to 18. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.
What’s Severe Morning Sickness?
Severe morning sickness is when nausea and vomiting get so serious that a pregnant woman vomits several times a day, loses weight, and gets dehydrated or is at risk for dehydration.
If this rare pregnancy-related condition isn’t treated, it can affect a woman's health and her baby's ability to thrive.
The medical term for severe morning sickness is "hyperemesis gravidarum" (hi-per-EM-eh-sis grav-ih-DARE-um), which means "excessive vomiting during pregnancy." It usually follows a similar timeline to normal morning sickness. But it can go longer, sometimes lasting for the whole pregnancy. Often, the symptoms get less severe as the pregnancy continues.
Most cases of hyperemesis gravidarum affect a woman's first pregnancy. But women who have it in one pregnancy are more likely to have it in future pregnancies.
What Causes Severe Morning Sickness?
The cause of severe morning sickness isn’t known. But it might be related to the hormone changes of pregnancy. A hormone called human chorionic gonadotropin, or HCG, might be to blame because severe morning sickness most often happens when HCG levels are at their highest in a pregnant woman's body.
Severe morning sickness also might run in families. It’s more common in women whose close family members (such as mothers and sisters) have had it.
Other things that can increase a woman's chances of having severe morning sickness include:
carrying multiples (twins, triplets, etc.)
history of motion sickness
migraine headaches with nausea or vomiting
What Problems Can Happen?
The nausea and vomiting that happen in severe morning sickness are so extreme that they can harm the mother and the baby. Not being able to keep down food makes it hard for the mom to meet her nutritional needs. So she might lose weight. And a loss of fluids, combined with the loss of stomach acid from vomiting, can cause dehydration and electrolyte imbalances.
If severe morning sickness isn’t treated, it can cause many problems, including organ failure and the early birth of her baby.
When Should I Call the Doctor?
Call the doctor right away if you’re pregnant and have any of these symptoms:
nausea that lasts throughout the day, making it impossible to eat or drink
vomiting three to four times per day or not being to keep anything in the stomach
brownish vomit or vomit with blood or streaks of blood in it
fainting or dizziness
peeing less than usual
a fast heart rate
a lot of headaches
unpleasant, fruity mouth or body odor
How Is Severe Morning Sickness Treated?
Treatments used for morning sickness, such as eating dry crackers in the morning or a bland diet, may be recommended for women with extreme morning sickness. But these might not help with severe symptoms.
Medical treatment can include:
a short period of not eating to rest the gastrointestinal system
intravenous (IV) fluids
vitamin and nutritional supplements
Some women might get medicine to stop the vomiting, either by mouth or through an IV. The doctor might recommend eating foods with ginger or taking vitamin B6 supplements to help ease nausea. It can also help to:
Eat a bland diet.
Eat frequent small meals.
Drink plenty of liquids when not feeling nauseated.
Avoid spicy and fatty foods.
Eat high-protein snacks.
Avoid sensory stimuli that can act as triggers (like specific smells or noises).
If a woman feels anxious or depressed about her condition, talking to a therapist or counselor might help her cope with her feelings.
What Else Should I Know?
With treatment, women with severe morning sickness can feel better and get the nourishment they need so they and their babies thrive. And lifestyle changes can help ease nausea and vomiting and make the pregnancy more enjoyable.
With time, symptoms usually do improve. And, of course, they stop by the time a woman's next journey starts: parenthood.
Feeling unwell? Pain? Which doctor should I go to?
Statistics show that in a number of cases (from 10 to 30%) visits to specialist doctors, to which the patient can make an appointment on his own or come without an appointment, are non-core. That is, a person fell ill, for example, in the stomach, and he decides that he needs to visit a surgeon. And the surgeon, having examined the patient, sees that the disease is not his profile. The person may have an indigestion, pancreatitis, or other NON-SURGICAL condition. A recent example: in January, 86 people with arthritis, arthrosis, dermatitis and osteochondrosis were seen by surgeons of our polyclinic outside their profile. Of course, they should receive medical care from specialists of a different profile.
Bottom line: wasted time for both: the specialist could use it to help "his" profile patient, and the visitor could use it to visit the right doctor.
The doctors of our polyclinic have prepared recommendations for residents of the Industrial District attached to GKP No. 2 in order to minimize the time and nerves spent and make the visit to the institution as effective as possible.
First, you can go without an appointment to the emergency department, which will refer you to the right specialist if necessary. What complaints are accepted in the emergency department, read here: http://gp2.medicalperm.ru/informacija-dla-pacijentov/zdes-vas-primut-bez-zapisi
Reasons for contacting (recording) a general practitioner
The general practitioner is the first and main doctor to whom the patient should go in case of any health problems. After a detailed examination and questioning of the visitor, the doctor will be able to determine what additional examinations and tests he should be directed to.
The therapist not only identifies possible internal diseases, but also proposes a plan for their treatment and then refers the patient to the narrow profile of the appropriate doctors who specialize in these pathologies.
The patient should make an appointment with a general practitioner if he/she has the following symptoms:
Temperature increase over 37 degrees
Pain and discomfort in any area of the body
Headaches for a long time
Cough, runny nose, sore throat
Weakness, bad mood, lack of appetite
Feeling tired from early morning
It is very important not to try to make a diagnosis on your own and not start treatment with improvised folk remedies. This should only be entrusted to experienced professionals. Otherwise, you can cause serious irreparable harm to your health.
You can find out how to make an appointment with a therapist on the main page of our website: http://gp2. medicalperm.ru/informacija-dla-pacijentov/kak-zapisatsa-k-vrachu/
records in our clinic compared to last year has decreased significantly.
What problems should be addressed to a surgeon
For help, a surgeon should be contacted in such cases:
If there were injuries, also foreign objects getting into tissues or organs
In the presence of local pain in the spine, knee and hip joints
Inflammation of internal organs, soft tissues
For hernias, frequent attacks of acute abdominal pain
Tumors (benign and malignant)
Malformations of organs.
The reasons for an urgent visit to the surgeon are:
Abscesses, boils or other purulent inflammatory formations
Acute, sudden onset and persistent abdominal or chest pain
Miscellaneous skin injuries: cuts, wounds (both with and without bleeding)
Chilliness of the legs (feet and toes), which is accompanied by lameness and fatigue
Swelling, redness and pain of any localization, which usually indicates purulent inflammation
Severe cases of ingrown nails and panaritiums
Also, if pain at the site of inflammation keeps you awake for a maximum of one night, you need to urgently go to the surgeon.
Dear patients! We hope that our recommendations will help you. With all questions, please contact our website, suggest topics that interest you. If the rubric Educational program for a patient is in demand by you, we will continue to maintain it on the website of GKP No. 2.
“How I got over the coronavirus”: an instructive story from the first person
Our own correspondent Denis Batov made sure from personal experience that in a mild form, coronavirus, like the common cold, can be treated at home.
Have pity on the doctors
The fact that the situation with coronavirus is really difficult became clear to me this spring, when a queue of several ambulances appeared near the admissions department of the covid hospital, created on the basis of the Tikhoretsk regional hospital, bringing patients from neighboring districts here.
In a conversation, the driver of one of the ambulances complained that he brought the child with a confirmed diagnosis, and the mother flatly refuses to leave him in the hospital.
– This is only the second trip in a day! Only in one direction, from the Caucasus region to Tikhoretsk, you need to rewind more than 60 kilometers! Now we are standing here, waiting, persuading. Why just take time from doctors? - the man rightly lamented.
One of the doctors working on calls also told me that people, having barely felt cold symptoms, ask for hospitalization and almost demand that they be immediately connected to a ventilator.
It is no coincidence that an action is being held across the country in support of doctors working in the “red zone” for months. The people in white coats themselves are asking citizens not to leave their homes unnecessarily in order to reduce the risk of infection and ease the burden on overcrowded hospitals.
Yes, over time, we have learned to wash our hands thoroughly with soap, use sanitizers, recognize each other in medical masks, not rush into hugs when meeting, and maintain social distance. It is a pity that although these measures reduce the risk of infection, they do not always protect, as I have seen from my own experience...
As it turned out, a meeting with covid is not as scary as one might imagine. But be careful, this disease, I want to warn you, is really insidious, and you need to keep your ears open with it.
If during the first three to five days of the coronavirus infection you do not have a high temperature and severe shortness of breath, then you should not worry too much. This means that the coronavirus proceeds like an acute respiratory disease, treat it like a common cold at home. And only if the symptoms are more severe, go to the hospital, doctors will always help you.
Vladimir Chulanov, Chief Freelance Specialist in Infectious Diseases of the Ministry of Health of the Russian Federation, Professor, Doctor of Science
In short, my close acquaintance with the "terrible and terrible" began with a rise in temperature and a cough that somehow descended too quickly into the bronchi. My first thought was: I caught a cold while jogging in the morning - it was just beginning to get colder. And, in theory, there is nothing surprising in this.
Mindful of the workload of our doctors, at the family council they decided not to immediately call an ambulance, they say, the usual acute respiratory disease, they already have emergency work. Moreover, the temperature did not rise above 38 degrees, and on the third day it completely disappeared. There was a dry cough, weakness, at times an unusual throbbing headache was felt. The X-ray, which was done in a paid clinic, showed that the lungs were clean, and this calmed me down a bit.
Isn't covid so bad?
The reason for concern was the loss of smell on about the fourth day of illness, and this, as you know, is one of the main signs of infection. But shortness of breath, which experts are talking about as one of the bells of the coronavirus, I personally did not have.
Just in case, he limited contacts and self-isolated. Later, suspicions that covid “came to visit” were confirmed by tests for the presence of antibodies to coronavirus, which he passed on the tenth day of illness.
Anesthesiologist Ramil Dursunov: “COVID-19 is a very insidious disease and develops rapidly”
In general, the entire period of treatment, along with self-isolation, since I was on vacation, took three weeks. Moreover, he did not take any antibiotics and antiviral drugs, he did not go to the doctors.
My wife became my family doctor, for which I promised her a doctor's degree. She also fell ill with coronavirus and suffered it in a mild form, even without fever and cough.
Our family was in quarantine for two weeks, it’s good that the school just had a vacation. By the way, two of our teenage children did not show symptoms of a viral disease.
Of the methods of treatment with which we defeated covid at home, the main one can be called the fact that we did not use any antibiotics and antiviral drugs so that the immune system could cope with the disease itself. They drank buckets of hot water with fresh raspberries and honey, an infusion of chamomile flowers, ate all this with lemon and ascorbic acid. The temperature was not brought down, the cough was treated with effervescent tablets of prolonged action and inhalations with an expectorant solution.
So in our family we suffered a disease that many are so afraid of. Perhaps the fact that people are sometimes panicky about the coronavirus is to blame for the media, which escalate the situation and at the same time say little about the fact that for most people this disease proceeds like a common cold.
I wanted to end on an optimistic note. But not everything is so simple in the case of this insidious infection, and in no case should one lose vigilance.
Almost simultaneously with me, my 61-year-old colleague from Tikhoretsk fell ill with the coronavirus. He was hospitalized, and he felt satisfactory, even found the strength to work on the next material, which he was going to publish after recovery, but . ..
Literally in a week, a still strong-looking man died of respiratory failure, even the ventilator did not help.
And there are many such tragic examples. Therefore, it is so necessary to observe a mask regime, keep a social distance, wash your hands with soap and water, avoid crowded places, use public transport less often.
As for me, now I know exactly how important it is to listen to your body during the appearance of signs of a cold, to monitor temperature, smell and taste. I remembered that in no case should you use antibiotics and antivirals without a doctor's prescription and call a doctor at home only if the high temperature lasts for several days.
How to treat coronavirus at home
Advice from the chief infectious disease specialist of Russia Vladimir Chulanov
1. Watch the temperature. If the thermometer scale does not show above 38 degrees for three days, you can use the usual antipyretics. Paracetamol will do.
2. If the temperature rises above 38 degrees and lasts for more than three days, this is a sign that the disease can become moderately severe, in which case you should consult a doctor.
3. To reduce the intoxication of the body during home treatment of coronavirus, as with any other infection, drink plenty of fluids. It is advisable to drink at least two liters of pure water per day.
4. It is important to monitor shortness of breath and respiratory rate. To do this, note how many respiratory movements you do per minute. The upper threshold is 22 quiet breaths in 60 seconds, if the respiratory rate is less, then there is nothing to worry about, you have no damage to the lung tissue. If you breathe more often - this is a reason to see a doctor.
Expert advice from the Center for Public Health and Medical Prevention of the Ministry of Health of the Krasnodar Territory:
If you or your loved ones get sick (a runny nose, sore throat, fever, general malaise, headache), you should not go to work, educational institution, kindergarten.