In first three months of pregnancy,frequently encountered problem is ” nausea and vomiting ” ( NVP ) -called as morning sickness
- More than 70% of women experiences morning sickness
- NVP is usually a self limiting condition
- NVP starts from 4-7 th week of pregnancy.Peak symptoms occur at 10-16 wk gestation
- Usually resolves by 20 th week of pregnancy.10% women continue beyond 22 wk
- Small percentage of women have a more profound course of nausea and vomitings- severe form called as hyperemsis gravidarum
WHY NVP ?
Hormones : placental hormones are responsible for NVP .Increased levels of HCG hormone having main role in NVP .Placental PG E2 ,IL -1 ,TNF alpha having association.
- Increased levels of estrogen and progesterone causes nitric oxide production ,there by relaxes the smooth muscle of gut and increase the risk of gastroesophageal reflux and vomiting .
- Decrease in TSH levels are observed with NVP and serotonin levels tooo
Gastrointestinal tract dysfunction : relaxation of lower esophageal sphincter and decreased motility of gut increases the risk of NVP
Psychological factors : psychological disturbances like neurotic tendencies ,hysteria,rejection of pregnancy,depression,stress,poverty,marital conflicts …all influences the NVP
WHO ARE MORE PRONE FOR NVP ?? RISK FACTORS :
- Younger women
- In first pregnancy
- Obese women
- Low income women
- Women with less than 12 yrs of education
- Sedantary lifestyle
- Twin gestation
- Women who had mothers ,who experienced trouble with NVP
- Personal history of motion sickness
- Migraine headache
- History of nausea on OCP’s in the past
MORNING SICKNESS AND OUTCOME OF PREGNANCY :
- Uncomplicated nausea and vomiting in pregnancy have been noted to have improved pregnancy outcomes ,fewer miscarriages ,preterm deliveries and still births
- Fewer instances of foetal low birth weight ,growth retardation and mortality
HOW TO EVALUATE NVP ?
- If NVP begins after 9 th week of gestation ,other causes should be investigated.When the condition is severe, potentially serious causes need to be ruled out
- Pyelonephritis common in pregnancy.Kidney ,gallbladder stones and liver disorders to be ruled out .Acute fatty liver ,pre eclamptic toxaemia are seen in pregnancy related nausea and vomiting.
- Non pregnancy related causes of nausea and vomiting: gastroenteritis ,appendicitis,diabetic ketoacidosis ,hyperthyroidism,vestibular lesions,migraine headaches etc
- Depending on presenting problem of pregnant women, following investigations can be done .CBP,RBS,urinary ketones,serum electrolytes ,LFT ,RFT,TSH,CUE ,USG abdominal and pelvis