Overview
Hyperemesis is no doubt a physiological disease. Treating
it as anything else is not therapeutic and can be detrimental to the mother
and her unborn child. Women left untreated may terminate a wanted pregnancy
to end the misery. Often secondary psychological challenges such as depression
and anxiety result and complicate management. Depression is a natural consequence
of being confined to home or bed, and unable to perform even simple daily activities,
much less care for one's family. Further, the accompanying anxiety often results
from the thought of vomiting and retching relentlessly for hours, as well as
feeling severely nauseous in between. Many women fear dying and feel guilty
that they may cause the death of their unborn child if they don't force feed
themselves, despite the inevitable vomiting that will follow. Treating the
complex physiological changes that cause such severe symptoms can be very challenging.
Further, each woman will respond differently to treatments since the cause
is multifactorial, so a single medication cannot be prescribed. It is becoming
clear that proactive intervention with a treatment
plan, can decrease both severity and duration, not to mention prevent
many complications for many women. The challenge is finding the treatment
that works
for each woman.
The HER Foundation Survey found bed rest and IV hydration to be two of the
most beneficial treatments for HG. This does not mean these alone are adequate,
rather these are nearly universally beneficial in women with HG.
IV fluids can be given at home in some countries at very low cost and minimal
risk. Fluids
can also include much-needed vitamins. Insurance coverage often includes home
IV care which allows the mother to have continuous fluids instead of
cycling from hydration to vomiting and dehydration. This cycle worsens
HG and delays recovery. Many women state they feel so much better after their
trip to the emergency room for IV fluids, only to begin vomiting and have to
return a few days later for more fluids. Home IV fluids can prevent this. A
regular IV can be left in for up to a week, provided it does not infiltrate
or become infected. Many doctors are not aware of the concept of stopping
the
dehydration cycle to avoid exacerbation of HG. Any mother producing
ketones or exhibiting signs of dehydration should receive IV fluids, preferably
with
IV vitamins. Vitamins are critical in mothers vomiting more than a
few weeks to prevent life-altering
complications.
- Medications
Antiemetic (anti-vomiting) medications are the most common and typically
most effective treatments for HG. The risks are often outweighed by the
benefits.
- Allergy Treatments
Sometimes HG symptoms can be managed with allergy management procedures.
- Complementary and Alternative Medicine (CAM)
CAM is sometimes effective in easing nausea and vomiting in milder
cases of HG, however, it most often is used in conjunction with allopathic
medicine (traditional medical care).
- Nutritional Therapies
Research shows that nausea and vomiting for more than a few weeks
causes significant deficiency of important nutrients, which can worsen nausea
and vomiting. If not replaced, a woman is at risk for more complications
and a prolonged recovery. These can be replaced via an intravenous (IV) line
or directly into the gastrointestinal (stomach/intestines) system.
- Behavioral Therapy
This therapy uses stimulus control and imaging procedures and is sometimes
used in mild cases with positive effects.
- Bed Rest
Prolonged bed rest can produce negative effects like atrophy and a
delayed recovery time after delivery. The best strategy is to do all you
can to get effective care and stay as mobile as possible. Physical therapy
may be beneficial.
- Sensory Deprivation Therapy (SDT)
This is essentially placing a women in a room without any interaction
or stimulation of any kind. She is denied any visitors such as her family
for days or weeks. This is cruel and ineffective for true cases of HG. Isolation
and secondary depression only worsen HG and increase the stress on a woman.
It should not be used. However, since odors, noise and light may worsen her
symptoms, it is helpful to minimize as much as she requests.
- Psychotherapy
This treatment may be effective for secondary complications such
as depression and anxiety, if used in conjunction with antiemetic medications
and hydration. It should never be used as a primary modality for cases of
HG. It is helpful to some women to manage feelings related to HG, or with
normal adjustments related to pregnancy and motherhood. Further, it is often
very helpful postpartum to manage PPD and PTSD. Since HG is not a psychological
disorder, this therapy must follow symptom management.
- Therapeutic Abortion
Abortion in most cases of HG is avoidable with aggressive use of the
available treatment options. Women who choose abortion do so most often because
of ineffective or inadequate treatment. Women left untreated sometimes become
so metabolically imbalanced, abortion is chosen to save the life of the mother.
However, it should be considered only a last resort. The long term consequences
cannot be overlooked or underestimated.
- Other Treatments
Women with HG have numerous other symptoms that often cause significant
distress. One is ptyalism (also called hypersalivation, sialorrhea or hyperptyalism).
Ptyalism is essentially an overproduction of saliva thought to be caused by increased
hormone levels. It happens in non-HG pregnancies as well and worsens nausea.
There are few treatments and most women just tolerate it by spitting into a cup
or tissue. In severe cases, a suction machine may be prescribed to avoid
skin irritation on the lips and chin from constant exposure to saliva. Other
issues are pain from prolonged periods of inactivity, which are typically managed
with over the counter pain relievers like Tylenol.
Updated on:
Aug. 09, 2006 |
