Clinical Case 021: Pregnant and puking

Emesis / hyperemesis gravidarum – idiopathic

Urinary tract infection / pyelo

Gastroenteritis / peptic ulcer disease / Helicobacter

Surgical causes – think gallbladder, appendix

Endocrine – Thyrotoxic state, DKA,

Multiple gestation

Molar pregnancy

Medications – Fe supps are common

Dehydration is the big one – often requiring admsission for IV rehydration.

Rare complications include – Wernicke’s encephalopathy, other neurological lesions (myelinolytic), ketoacidosis

Mental health problem are common – depression and anxiety.

Well, a 2010 Cochrane review of the subject basically came up dry! They looked at acupressure, ginger, pyridoxine, antiemetics etc and saw no consistent benefit from any study or intervention.

So what do we do?

IV rehydration seems to help – usually when you have ketosis and objective evidence of dehydration

Antiemetics – metocloramide, promethazine

Steroids have been used

I like 5HT drugs – ondansetron – comes in a wafer, so women can use it at home and attempt to stay away from the hospital

Ginger can help, unlikely to harm.

Consider using thiamine supplemenation / multiB vitamins and watch out for low calcium – risk of later osteoporosis.

Nice review here on the topic. Surprisingly the babies of these poor women do well, there is an increased incidence of small-for-age, low birth weight and premature delivery. The miracle is that the outcomes are not worse given the sometimes severe and prolonged nutritional problems!