Vomiting during pregnancy is a common symptom and occurs due to hormonal and physiological changes. It ranges from mild morning sickness to severe hyperemesis gravidarum.
Types of Vomiting in Pregnancy
- Simple Vomiting (Morning Sickness)
- Hyperemesis Gravidarum (Severe Vomiting in Pregnancy)
1. Simple Vomiting (Morning Sickness)
Definition:
- Nausea & occasional vomiting that occurs in early pregnancy (usually 6–12 weeks).
- Does not affect maternal health or nutritional status.
Causes:
- Hormonal: Increased hCG, estrogen, and progesterone levels.
- Psychological: Emotional stress and anxiety.
- Metabolic: Altered carbohydrate metabolism.
Clinical Features:
- Mild nausea & occasional vomiting (mostly in the morning).
- No dehydration or weight loss.
Management:
- Dietary Changes:
- Eat small, frequent meals.
- Avoid spicy & fatty foods.
- Dry toast or biscuits in the morning.
- Hydration: Drink plenty of fluids.
- Vitamin B6 (Pyridoxine) 10–25 mg 2–3 times daily.
- Anti-emetics (if needed):
- Doxylamine + Pyridoxine (Diclegis).
2. Hyperemesis Gravidarum (Severe Vomiting in Pregnancy)
Definition:
- Severe, persistent vomiting leading to dehydration, weight loss (>5% of body weight), electrolyte imbalance, and ketosis.
- Usually occurs between 8–12 weeks of pregnancy but can last longer.
Risk Factors:
- Multiple pregnancy (Twins, Triplets).
- Molar pregnancy (Hydatidiform mole).
- Primigravida.
- Psychological factors (Stress, Anxiety).
- Personal or family history of hyperemesis gravidarum.
Pathophysiology:
- Increased hCG levels → Delayed gastric emptying.
- Altered metabolism → Ketosis & acidosis.
Clinical Features:
- Severe, persistent vomiting (unable to retain food or fluids).
- Dehydration: Dry tongue, sunken eyes, reduced skin turgor.
- Weight Loss (>5% of body weight).
- Electrolyte Imbalance:
- Hypokalemia → Weakness, muscle cramps.
- Hyponatremia → Dizziness, confusion.
- Ketosis:
- Acetone smell in breath.
- Ketonuria (ketones in urine).
- Complications:
- Wernicke’s Encephalopathy (Vitamin B1 deficiency).
- Liver Dysfunction (Jaundice, Fatty Liver).
- Mallory-Weiss Tears (Esophageal rupture due to forceful vomiting).
Diagnosis of Hyperemesis Gravidarum
Laboratory Tests:
- Urine Ketones (Ketonuria): Positive in severe cases.
- Electrolytes:
- Hypokalemia (↓ Potassium).
- Hyponatremia (↓ Sodium).
- Liver Function Tests:
- ↑ Bilirubin (if hepatic involvement).
- ↑ AST/ALT (Liver enzymes).
- Thyroid Function Tests:
- May show transient hyperthyroidism due to excess hCG.
Management of Hyperemesis Gravidarum
Mild Cases (Home Treatment):
- Small, frequent meals (high in carbohydrates, low in fat).
- Ginger supplements (Anti-emetic effect).
- Vitamin B6 (Pyridoxine) + Doxylamine (Unisom).
Moderate to Severe Cases (Hospital Admission Required):
- IV Fluids (Ringer’s Lactate, Normal Saline with Potassium).
- Correction of Electrolytes (Potassium, Sodium).
- Anti-emetics:
- Metoclopramide (10 mg IV/IM every 8 hours).
- Ondansetron (4–8 mg IV every 8 hours).
- Promethazine (Phenergan) 12.5–25 mg IM/IV.
- Thiamine (Vitamin B1) Supplementation → To prevent Wernicke’s encephalopathy.
- Steroids (Severe Cases):
- Hydrocortisone 100 mg IV followed by Prednisolone.
Indications for Termination of Pregnancy (Rare Cases):
- If severe, life-threatening complications develop despite treatment.
Comparison: Morning Sickness vs. Hyperemesis Gravidarum
|
Feature |
Morning Sickness |
Hyperemesis Gravidarum |
|
Onset |
6–12 weeks |
8–12 weeks |
|
Severity |
Mild |
Severe, persistent |
|
Effect on Nutrition |
No weight loss |
Weight loss >5% |
|
Dehydration |
Absent |
Present |
|
Ketonuria |
Absent |
Present |
|
Hospitalization |
Not required |
Required |
Summary of Vomiting in Pregnancy
|
Condition |
Key Features |
Management |
|
Morning Sickness |
Mild nausea & vomiting, No dehydration |
Dietary changes, Vitamin B6, Anti-emetics |
|
Hyperemesis Gravidarum |
Severe vomiting, Dehydration, Weight loss, Ketonuria |
IV fluids, Electrolyte correction, Anti-emetics,
Thiamine |
1. Ipecacuanha
- Constant nausea, not relieved even after vomiting.
- Profuse salivation, excessive mucus in the mouth.
- Vomiting of food and bile, sometimes blood-streaked.
- Gagging or retching with no production of vomit.
- Clean tongue despite severe nausea.
2. Nux Vomica
- Severe nausea in the morning, worsened by eating.
- Vomiting with a sensation of incomplete relief.
- Irritable, oversensitive, dislikes noise and strong smells.
- Constipation, with an urge to vomit but difficulty in doing so.
- Worse after coffee, alcohol, or heavy meals.
3. Sepia Officinalis
- Morning sickness with a feeling of emptiness in the stomach.
- Aversion to food, especially meats, fats, and milk.
- Nausea triggered by the smell of food, perfumes, or cooking odors.
- A dragging sensation in the lower abdomen.
- Emotional indifference, irritability, and desire to be left alone.
4. Colchicum Autumnale
- Intense nausea from food odors (especially eggs, fish, meat).
- Severe retching with little vomiting.
- Extreme sensitivity to even the thought of food.
- Motion and movement worsen nausea.
- Bloating and excessive gas formation.
5. Symphoricarpus Racemosus
- Constant nausea with inability to tolerate any food or drink.
- Vomiting of bile or sour fluids.
- Intolerance to water, even a sip induces vomiting.
- Worse in the morning and during pregnancy.
- Better when lying on the right side.
Key Takeaways
- Ipecacuanha: Persistent nausea, no relief even after vomiting.
- Nux Vomica: Vomiting due to overeating, irritability, and food intolerance.
- Sepia: Morning sickness worsened by odors, emotional dullness.
- Colchicum: Nausea from the smell or thought of food.
- Symphoricarpus Racemosus: Vomiting of bile, intolerance to food & water.
