Introduction
When the subject of pregnancy is raised, the same problems are often listed over and over again. The pregnant woman feels bloated, has trouble with skin changes and her breasts hurt. Another complication is very often the focus of a pregnancy and affects a large proportion of expectant mothers – vomiting or emesis gravidarum.
Depending on the clinical study, 25 to 90% of pregnant women suffer from nausea and vomiting, at least in the first third of the pregnancy. This is a natural reaction of the body to the changes that pregnancy entails for the female body and usually only needs to be treated conservatively. As a serious disease, hyperemesis gravidarum can develop from this, whereby the transition cannot be exactly defined and is fluid. The disease belongs to the Gestoses, a group of diseases that only occur during pregnancy and are limited in time by pregnancy. On average, only 1-2% of pregnant women develop hyperemesis gravidarum.
Symptoms and complications
It should be clear how emesis gravidarum is manifested. Everyone has at some time in his or her life consciously experienced the process of vomiting and knows the oppressive and extremely unpleasant feeling. Pregnancy vomiting usually occurs in the morning without any trigger of nausea.
The vomiting is performed on an empty stomach (“vomitus matutinus”), which puts additional strain on the stomach, the esophagus and the pharynx, since only stomach acid can be choked out. This can cause heartburn and damage the teeth. During the day, vomiting accumulates up to 10 times on average.
Slight weight loss can be the result of normal emesis gravidarum and is not dangerous if you are initially normal weight (or overweight). The complications become worse when the more aggressive form of hyperemesis gravidarum occurs. The longer-term and stronger or more frequent vomiting can lead to various deficiency symptoms.
The patient’s weight decreases significantly, which can be especially dangerous in women with low body mass or underweight. A state of dehydration sets in: the constant feeling of thirst cannot be satisfied satisfactorily, since vomiting occurs again with greater fluid intake, the mucous membranes are reddened and the tongue is dry, the body temperature rises and urination is minimized. The electrolyte balance is also out of control, as these cannot be supplied to the body according to consumption.
Since not enough food can be taken in through vomiting, the blood sugar level (hypoglycaemia) drops and so-called ketone bodies are formed to supply the cells with the necessary nutrients. These can be detected in the blood and urine and can be used to diagnose the severity of the illness. The patient is clearly in a bad state of health.
In addition, the liver may be restricted in its function. This is impressively demonstrated by an icterus, which the patient then exhibits. In an icterus, also known as jaundice, the interior of the eye (sclerae) changes from white to yellowish and the skin also takes on a distinct yellow tinge.
These changes are reversible after one treatment. The mechanism by which pregnancy vomiting occurs is not yet fully understood. However, there are theories that can provide an explanation, at least in the beginning.
The hormonal change most likely plays a major role in the clinical picture of emesis gravidarum, since many of the complications in pregnancy are hormone-based problems. The hormone hCG, the human chorionic gonadotropin, seems to be particularly important. Its task is to maintain the pregnancy after the egg has been fertilized.
It is produced in the placenta and causes various changes in the maternal body, as well as the production of pregnancy-maintaining hormones such as progesterone. About 24 hours after the egg is fertilized, the level of progesterone begins to rise. In the 8th to 12th week of pregnancy the level of hCG reaches its maximum.
After that, the placenta is fully mature and produces even those hormones necessary to maintain the pregnancy. The hCG level drops again. During this period, the symptoms are relieved relatively quickly, which suggests the connection.
Furthermore, progesterone and estrogen, i.e. other female hormones, as well as the thyroid gland (hyperthyroidism) could also play a role.A further approach to the clarification of the basics of disease development deals with the psychosomatic aspects, which generally occupy an important position in medicine as well as in pregnancy. It is assumed that the majority of all cases of hyperemesis gravidarum have a psychological origin, which is then reflected in the physical. Problems can arise when a woman is confronted with the fact of becoming a mother soon.
Due to the limitations and increased responsibility, the fetus may be perceived as a so-called “blackhead”, which hinders the formation of a maternal-child symbiosis (bond). Among other things, this can result in massive vomiting during pregnancy. The therapeutic procedure for such psychosomatic problems is usually quite simple.
The mother is admitted as an in-patient for pregnancy-related vomiting. Through the presence and care of the attending physicians and nursing staff, the mother is relieved of some of the responsibility and cared for by the staff. These simple circumstances dampen the pressure on the expectant mother and usually lead to the abatement of hyperemesis gravidarum within a very short time.
