Hyperemesis Gravidarum

Differences between Normal and Abnormal

According to a research article by Lee and Saha (2013), 70 to 80 percent of all pregnant women experience nausea and vomiting. Nausea and vomiting during pregnancy is believed to be caused by rapidly rising serum levels of the hormones human chorionic gonadotropin (HCG) and estrogen (Cleveland Clinic, 2012). However, when nausea and vomiting becomes severe to the point that it can cause electrolyte imbalances, weight loss, and dehydration (Cleveland Clinic, 2012), then it becomes a disorder called Hyperemesis Gravidarum (Lee & Saha, 2013). The Cleveland Clinic (2012) describes Hyperemesis Gravidarum as “an uncommon disorder in which extreme, persistent nausea and vomiting occur during pregnancy.”

Risk Factors

Women are at risk for developing HG if they are now pregnant with more than one child, overweight, pregnant for the first time, had Hyperemesis Gravidarum in a past pregnancy, or have trophoblastic disease (Cleveland

Clinic, 2012). Trophoblastic disease is a tumor that develops after conception, instead of a healthy fetus (National Cancer Institute, 2016).
Signs and Symptoms
Hyperemesis Gravidarum usually occurs between the 5th and the 22nd week of pregnancy (Richards & March, 2016). It is manifested by severe, persistent nausea during pregnancy, causing the woman to vomit more than 3 to 4 times a day to the point that she loses more than 10 pounds of her weight, develops headaches, constipation, and dehydration. Dehydration can cause her to feel dizzy, lightheaded, and even make her faint (Burd, 2015). Due to this, the woman may end up going to the emergency room for treatment, thus making Hyperemesis Gravidarum just second to preterm labor as a reason for hospital admission (Summers, 2012). During a physical exam, there may be a decrease in blood pressure but an increase in heart rate due to the dehydration.
Tests
The doctor may order a complete blood count, electrolytes, and urine ketones to check for dehydration. The doctor may also run tests to look for liver and gastrointestinal problems. A pregnancy ultrasound can be done to determine if the woman is carrying more than one baby and also look for a hydatidiform mole (Burd, 2015). Hydatidiform mole is another type of trophoblastic disease (White, 2014).
Life Threatening Factors
It is critical that the woman gets medical attention as soon as possible because Hyperemesis Gravidarum can lead to significant maternal and fetal morbidity (Lee & Saha, 2013). The mother can develop esophageal rupture or perforation, pneumothorax, seizures, coma, or even death as a result of severe HG. On the other hand, the baby can be born prematurely, have a low birth weight, or be small for the baby’s gestational age (Fejzo, 2015). If the woman gained less than 15 pounds during her pregnancy, then the fetal is at risk for dying inside her womb (Lee and Saha, 2013). Even if HG did not go to this extreme, woman should get medical treatments because over half of HG’s onset is sudden with rapid deterioration to severe and debilitating symptoms (Dean, 2014). HG can make them feel so sick and weak that they can’t work at their job or even perform any activities inside or outside of the home, thus decreasing their quality of life (Fejzo, 2015).

Medical Treatments
Fortunately, there are medical treatments that can help the mother when she is sick with HG.

These medical treatments include oral or IV fluids for dehydration and antiemetic drugs for nausea (Leifer, 2011). A combination of Unisome (doxylamine) and Vitamin B6 is effective against nausea and vomiting (Burd, 2015). If the woman cannot eat enough to get the nutrients for herself and for her baby, then total parenteral nutrition is administered to supply her and the baby with the nutrients that they need.

Nursing Education

Once the woman is well enough to go home, teach her to avoid anything that can trigger her nausea and vomiting such as smells of a perfume. Also, teach her to eat and drink whenever she is able to (Burd, 2015). It’s recommended that she eats bland foods, dry foods like crackers, or even small, frequent meals to control her nausea and vomiting, instead of starting on regular foods right away (Cleveland Clinic Foundation, 2012).

Nursing Interventions for Preventing

Complications
For prevention, planning and preparation before pregnancy is important. Thus, nursing interventions should include recommending women to eat small frequent meals with protein source before pregnancy because this will help develop a healthy habit. Teach the pregnant woman to monitor her own fluid balance and/or conduct keto-analysis at home, which can give the woman a sense of control over her symptoms. It’s also important that treatments for severe HG is discussed beforehand. That way the woman will feel more comfortable accepting the medical treatments if her HG symptoms become severe. Hospital admission should also be discussed in the event that the woman should need to go to the hospital due to HG symptoms or any other reasons. This will help ease her state of mind because she will know when she should go, how to get there, and what to expect at the hospital. Assessing and finding support for the woman is also important. That way, she will have someone to help her and her family if she became too sick that she cannot fulfill her duties. This include child care, household chores, and self-cares (Dean, 2014).
Conclusion
In sum, it is important that women know when the common nausea and vomiting during pregnancy has exacerbated to Hyperemesis Gravidarum. Women should also know what HG is, how to prevent it, and what treatments are available if they were to develop the disorder. This knowledge will enable them to gain control of their HG symptoms so that they can take care of themselves and their growing fetus.