Hyperemesis gravidarum

Excessive vomiting in pregnancy is a rare condition found in approximately 1 in 500 pregnancies. Nausea
and vomiting persist and dehydration and keto-acidosis escalate with the result that the serum
electrolyte balance is disrupted. The liver and kidney tissues necrose and malfunction, polyneuritis and
encephalopathy may result due the lack of vitamin B, and sodium and potassium imbalance affects the
activity of the heart musculature.

Vomiting over an extended period affects the availability of the intrinsic factor essential for the
absorption of vitamin B12. The vitamin C and folic acid levels fall and the whole results in anemia.

The aetiology of hyperemesis gravidarum is unclear but is known to be associated with multiple
pregnancy, hydatidiform mole and a history of unsuccessful pregnancies. A proportion of women who
experience this condition will have a recurrence in subsequent pregnancies.

Assessing the mothers condition

An accurate history regarding previous pregnancy experiences is essential. Evidence of vomiting in

previous pregnancies will alert the midwife to a possible recurrence.

The midwife should enquire of all women who attend for early antenatal care whether they are
experiencing nausea or vomiting and the answer should be recorded. On subsequent encounters
symptoms have improved and whether the nausea and vomiting are accompanied by pain; the location
of any pain should be elicited. This information is essential if the correct cause of the vomiting is to be
diagnosed.

The mothers appearance should be observed and dryness or inelasticity of the skin should be noted.
Where the condition has become serious, jaundice may be apparent which signifies liver damage. The
mothers breath will smell of acetone; her tongue and she may complain of blurred vision. The mothers
weight will be less than expected for gestation. She may even lost weight since the beginning of
pregnancy. Lack of food and persistent vomiting will result in anemia.

The pulse rate will be leak