HYPEREMESIS GRAVIDARUM

Sandra* lay still in her hospital bed looking frail. She had lost track of days. She couldn’t even remember whether she had taken a shower or not. The only time she moved was when she leaned over to spit in the receiver the nurse had put beside her.

Three weeks before, Sandra was over the moon. After three years of trying to conceive, she had found out she was finally going to be a mom. She couldn’t wait for her husband to get home from work so she could tell him. Though she always imagined how she would take her husband out to a fancy dinner then break the news, it never came to pass. By the time he came through the door, she couldn’t hold back and she blurted out the news before he could even put his coat down.

Tim* was overwhelmed. He was beside himself with excitement. That night the couple could not sleep. They talked endlessly about their baby and planned for the future of a six-week embryo! The next day, they went to see the doctor and start the antenatal care. Things went quite smoothly for the next two weeks. Sandra’s tests were all good and the first ultrasound showed that the little one was growing fine.

Then came the ninth week and their lives suddenly turned upside down. Sandra suddenly developed intolerance to everything. She could not stand smells. It did not matter whether it was soap, perfume, lotion, detergent of fabric softener. She couldn’t tolerate the smell of meat and she turned vegetarian. She would sit in the garden while dinner was prepared since she could not tolerate the smell of frying onions.

One evening, in an effort to cheer her up, Tim came home with a bunch of fresh roses. One look at the beautiful flowers and Sandra took off to the bathroom to throw up. She threw up so hard, Tim found her on the bathroom floor, a soiled mess. The flowers were tossed out immediately.

What followed was a non-stop cycle of spitting up saliva, wretching and vomiting. Sandra was confused. She had heard of morning sickness but this was an all-day sickness. She went to see the doctor and he prescribed medication to reduce the vomiting and gave her a sick-off. It did not work. She threw it up the medication as soon as she swallowed it. She was unable to retain anything, including water and her pregnancy supplements.

One night, as she sat on the bathroom floor, exhausted after a bout, she noticed that the vomit was blood-streaked. She broke down and started sobbing. Tim, who had gone to the kitchen to refill her water bottle, could not get her to calm down. He carried his wife to the car and drove through the quiet city to the hospital. He only realized he was still in his pajamas at the emergency department reception.

During the admission process, Sandra could not even remember the last time she had passed urine. The doctors swiftly ordered for a battery of tests and set up fluids to rehydrate her thirsting body. Though the tests done revealed that she was going into acute renal failure, aggressive rehydration was able to correct this in the subsequent days she was in the ward.

However, no medication could stop the urge to spit. She would spit up all day and only got respite when she was asleep. She only tolerated a liquid diet and citrus fruits. She could not comprehend how a natural process of procreation could end up being life-threatening. Tim knew she was on the path to recovery when she asked the doctor if he had confirmed that she had not thrown up her baby.

Everyone told her that the vomiting would settle down after the first trimester but this did not happen for Sandra. She threw up until the baby came. It took another three weeks before the urge to spit would settle. Her daughter is now nine years and Sandra has not gathered enough courage to board the rollercoaster of pregnancy again.

Sandra epitomized the worst case scenario of hyperemesis gravidarum. Several mothers have to undergo admission or at least daily intravenous fluid administration to survive it. The Duchess of Cambridge, Kate Middleton, caused quite a stir in 2012, when she had to be admitted at The King Edward VII's Hospital in central London for three days.

Just what is this condition? It is excessive vomiting occurring during pregnancy as a result of the pregnancy hormone, human Chorionic Gonadotrophin (hCG), which is made in the placenta. It is generally at its worst between nine and twelve weeks of pregnancy for most moms. The vomiting is so severe that it leads to upset of the body’s normal physiologic equilibrium.

Hyperemesis gravidarum negatively impacts on the pregnant mom by causing dehydration due to inability to keep down fluids. Neglected dehydration leads to kidney injury and resultant renal failure. Then, hunger sets in as the body gets starved for lack of sugar and other essential nutrients. It begins to break down the fat stores to utilize this as an energy source, resulting in accumulation of ketones, a by-product that causes acid to accumulate in the body. The weight loss is inevitable.

This condition is more likely to happen in multiple pregnancy, in molar pregnancy (an abnormal pregnancy which does not result in a live baby) and in pregnancies complicated by urinary tract infections. The doctor actively seeks to rule out these complications as part of care.

Treatment comprises aggressive dehydration, controlling the vomiting using intravenous medication. Supplementing vitamins and minerals that may be deficient and managing the stomach irritation by reducing the stomach acid.

The baby may be doing just fine in the midst of this storm but mommy needs to be taken care of in order to survive the incubation period!