Breast Infection (Mastitis) Treatment in Indore

HG is a form of extreme nausea and vomiting during pregnancy that exceeds the normal condition often referred to as “morning sickness.”

This could lead to dehydration, electrolyte imbalance, malnutrition, and weight loss that require medical intervention.

ICD-10 Code: O21.1

Onset: Generally starts in the first trimester, between weeks 4-10

Duration: May continue throughout pregnancy, but often improves after 20 weeks

⚕️ Difference Between Morning Sickness and HG

Feature Morning Sickness Hyperemesis Gravidarum

Frequency of vomiting\tOccasional\tPersistent (several times daily)

Weight loss Minimal >5% of prepregnancy weight

Dehydration No Yes

Need for hospitalization\tRare\tCommon

Effects on lifestyle: Mild to moderate, Severe, disabling

Causes and Risk Factors

The exact cause is not fully understood, but several factors are believed to contribute:

1. Hormonal Factors

Human chorionic gonadotropin (hCG): High levels correlate with HG.

Estrogen and progesterone can slow gastric motility and, therefore, contribute to nausea.

2. Genetic Predisposition

Family history of HG increases the risk.

Recurrence in subsequent pregnancies is common.

3. Gastrointestinal Factors

Infection with Helicobacter pylori may contribute in some cases.

4. Psychological Factors

Previously thought to be psychogenic but now considered secondary to physiological causes. Symptoms may be exacerbated by stress.

5. Other Risk Factors

First pregnancy

Multiple gestations (twins, triplets)

Molar pregnancy

Female fetus

Obesity

Hyperthyroidism

⚠️ Signs and Symptoms

Typical symptoms include:

Severe and persistent nausea and vomiting

Inability to keep food or fluids down

Weight loss >5% of pre-pregnancy body weight

Dehydration includes such symptoms as dry mouth, sunken eyes, and reduced urine output.

Fatigue and dizziness

Ketonuria is the presence of ketones in urine due to starvation.

Electrolyte imbalances, especially low potassium

Rapid heartbeat, low blood pressure

Diagnosis

Diagnosis is clinical and supported by laboratory findings.

Diagnostic Criteria:

Persistent vomiting not associated with other causes

Weight loss greater than 5% of pre-pregnancy weight

Ketonuria or ketonemia

Electrolyte imbalance: ↓Na⁺, ↓K⁺, ↑Hct

Absence of other medical causes of vomiting, such as hepatitis, UTI

Investigations

Urinalysis: Ketonuria, specific gravity ↑

Blood tests: Electrolyte disturbances, increased hematocrit, renal function

Thyroid tests - to exclude thyrotoxicosis

Ultrasound: To exclude multiple or molar pregnancy

Treatment and Management

1. Supportive Therapy

Hospitalisation for severe dehydration or weight loss

IV fluids: Normal saline with potassium supplementation

Electrolyte correction

Vitamin replacement: Thiamine (B1) before glucose to prevent Wernicke’s encephalopathy

2. Nutritional Support

Small, frequent meals

Avoiding triggers-strong odours, spicy/fatty foods

Dry foods (toast, crackers)

High-protein snacks

Severe cases may require: enteral (nasogastric) or parenteral nutrition

3. Pharmacologic Treatment

(Given under medical supervision)

Drug Class Examples Notes

Antiemetics: Metoclopramide, Ondansetron, Promethazine. First-line or second-line therapy

Antihistamines: Doxylamine, Diphenhydramine. Commonly used

Vitamin B6 (Pyridoxine)10–25 mg every 8 hrsSafe and effective

Corticosteroids Methylprednisolone For refractory cases only

Ginger supplements\tNatural remedy\tMay help mild nausea

Complications

Maternal:

Severe dehydration and an electrolyte imbalance

Wernicke’s encephalopathy (due to thiamine deficiency)

Mallory-Weiss tear (oesophageal tear due to vomiting)

Psychological stress and depression

Liver and kidney dysfunction

Fetal:

Intrauterine Growth Restriction (IUGR)

Low birth weight

Preterm delivery

Rarely, fetal demise may occur if severe malnutrition persists

Preventive and Self-Care Measures

Although it is not always possible to prevent HG, early recognition and management can lessen the severity.

Preventive Strategies

Preconception care:

Treat the underlying gastrointestinal or thyroid disorders.

Ensure good nutritional status before conception.

Early pregnancy care:

Start vitamin B6 and prenatal vitamins before conception or early in pregnancy

Avoid potent odours or any food that nauseates you.

Eat small, frequent meals and don’t let the stomach get empty.

Keep well-hydrated with small sips of fluids throughout the day.

Adequate rest and stress management.

Monitor early symptoms:

If persistent vomiting or early weight loss develops, seek medical evaluation. Prognosis: Most women improve by 20 weeks of gestation. Symptoms can occur again in future pregnancies. With proper management, maternal and fetal outcomes are usually good.