Morning sickness is the lay term used for the nausea and vomiting that is associated with pregnancy. This is a normal phenomenon in pregnancy, although the name says morning sickness, nausea and/or vomiting can occur any part of the day. This is seen most of the time during the first three months of pregnancy and usually resolves within 14 to 16 weeks, in some women this continues throughout the pregnancy. Mild morning sickness does not affect the baby, but it can affect your day to day work and affect your quality of life. Severe or untreated morning sickness can cause problems in the mother and the baby.
Complications Of Morning Sickness
The complications of morning sickness are dehydration, electrolyte imbalances, hyperemesis gravidarum which is severe nausea and vomiting; and deep vein thrombosis.
Dehydration. You must be vomiting whatever you drink or eat; you barely eat or have fluids for the day. So, you can be dehydrated if you do not have enough fluids. You are losing lots water from your body by vomiting, so you need to drink more to maintain the normal body requirement for a day plus the amount of fluid you lost for that day. Usually the amount of fluid is calculated by your body weight. But roughly for a woman at least 2-3 L of fluid is needed per day. You need to drink 50 ml or 75 ml additionally according to the volume of the vomitus (50 ml if it is a moderate amount and 75 ml if you vomit a lot). Even if you vomit fluid intake should be maintained. You should not drink just water, but have a mix of water, fruit juices and oral rehydration fluids.
Electrolyte Imbalance. Electrolyte Imbalance is a complication of morning sickness. This occurs because when you vomit along with the water the electrolytes also go out. With vomiting it is mainly the H+ and Cl- that gets removed. In order to balance the electrolytes levels body removes some essential electrolytes and absorb some electrolytes that are harmful. This can cause different problems in organs, especially the heart. That is why we say not to have plain water when you are replacing fluids because water does not contain any electrolytes. You need to have fruits juices or oral rehydration fluids which contains the exact number of electrolytes you need for a day.
Hyperemesis Gravidarum. This is a severe form of nausea and vomiting, it is quite uncommon occurring in 1 in 100-200 pregnant women. Clinical features
- Severe Morning sickness for a long period
- Weight loss
- Hypotension when standing up
- Increased heart rate
Your quality of life will be severely affected and you might even be in a depressed state. The Morning sickness are so severe that you will not be able to tolerate any oral fluid. You need to get to a hospital so that IV fluids can be started, if you are not treated you can be dehydrated, lose weight and can even affect the growth of the baby.
Treatment For Morning Sickness
- You need to admit in the hospital for the treatment
- IV fluids – these are given to replace the fluid, electrolytes and nutrients that have been lost. Then in order to maintain the fluid balance IV fluids are continued.
- Nasogastric feeds – tube is passed through the tube to the stomach and fluid can be given through this tube.
- First line antiemetics like cyclizine, promethazine, chlorpromazine to stop the Morning sickness.
- Second line antiemetics are metoclopramide and ondansetron.
- Proton pump blockers such as omeprazole, H2 blockers such as ranitidine and antacids can be given to prevent gastroesophageal reflux.
Deep Vein Thrombosis. All pregnant women are at an increased risk of getting deep vein thrombosis (DVT) due to the increased circulating estrogen hormone levels. Women with morning sickness who are in dehydration are at more risk of getting DVT.
Morning sickness is the lay term used for the nausea and vomiting that is associated with pregnancy. This is seen most of the time during the first three months of pregnancy, in some women this continues throughout the pregnancy. Mild morning sickness does not affect the baby but it can affect your day to day work. Severe or untreated morning sickness can cause problems in the mother and the baby.
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