Hyperemesis

Morning sickness

Morning sickness is feeling like throwing up, also called nausea, and throwing up, also called vomiting, that occurs during pregnancy. Morning sickness can happen at any time of the day or night. Almost all women experience some degree of nausea or vomiting during pregnancy. The most common form of pregnancy-related nausea can be distressing and make you feel very unwell, but it usually does not lead to nutritional deficiency or illness in the mother or the fetus.

Alvorleg svangerskapskvalme rammar berre eit fåtal gravide. Det gjev så ekstrem kvalme og så store plager at du treng helsehjelp.

Common morning sickness

Nausea is most common during the first 12 weeks. As the pregnancy progresses, symptoms usually improve. Dietary changes (small, protein-rich meals) and/or over-the-counter anti-nausea medication may help relieve symptoms. Ask your general practitioner (GP) or pharmacy staff for advice.

Severe morning sickness

Some pregnant women (1–3%) develop severe pregnancy-related nausea (hyperemesis gravidarum), which can lead to fluid loss (dehydration), electrolyte imbalances, and nutritional deficiency. Hospital treatment is often required.
Severe nausea and vomiting affect work capacity and the ability to participate in everyday activities. The most feared, but very rare, complication for the mother is brain injury due to vitamin B1 (thiamine) deficiency.

Several studies have shown that the baby may have an increased risk of being born prematurely or with low birth weight. This risk is higher if the woman’s fluid and nutritional intake is not adequately corrected. It is therefore important that pregnant women with severe pregnancy-related nausea receive treatment and follow the treatment plan and advice given by their doctor or midwife.

Referral and assessment

Pregnancy-related nausea can be assessed using a questionnaire called SUKK in Norwegian, known in English as PUQE (Pregnancy-Induced Nausea Quantification). It consists of three questions:

• On average in a day, for how long du you feel nauseated or sick to your stomach?
• On average in a day, how many times do you vomit or throw up
• On average in a day, how many times have you had retching or dry heaves without bringing anything up?

A high score indicates severe pregnancy-related nausea.

The doctor reviews the questionnaire with the pregnant woman and then classifies the nausea as mild, moderate, or severe. We also assess whether other illnesses or factors could be contributing to the nausea.

For relatives, it can be difficult to understand how ill a woman with hyperemesis can be. It is important that she receives good support from family and friends and feels that they are there for her. Anxiety, worry, and an unstable partner or home situation can worsen the condition. Talking to a doctor, midwife, or other qualified healthcare professional can be very helpful.

Before

You will be weighed and measured. An ultrasound examination will also be performed to confirm gestational age and fetal wellbeing. Urine and blood tests will be taken, among other things, to assess salt balance, electrolytes, and nutritional status.

Women with mild to moderate pregnancy-related nausea can often be treated at home with symptom-relieving measures such as anti-nausea medication, dietary advice, vitamin supplements, and rest. Full or partial sick leave is often necessary at this stage.

During

Pregnant women with severe pregnancy-related nausea often require hospitalization. Treatment includes anti-nausea medication and the administration of fluids, electrolytes, and nutrition, including vitamin supplements.

If eating or drinking is not possible, the best way to provide nutrition and essential vitamins is through a feeding tube—a thin tube inserted into the stomach. Nutrition is delivered through the tube.

During the hospital stay, general condition, weight, urine tests, and blood tests are monitored regularly. Once the woman’s condition improves, she may be discharged with a follow-up plan and instructions for continued treatment at home. Many women are discharged with a feeding tube and continue tube feeding at home

After

Rest and the opportunity for sleep and recovery are central to treatment. Help and support from a partner, family, and friends are crucial for successful treatment. Psychological support and a calm environment are important parts of care.

Strong smells can trigger nausea. People around the pregnant woman should therefore avoid wearing strong perfume. Avoid strong odors such as cooking smells, strongly scented foods, and flowers, as these can provoke nausea and retching.

Eat small meals. The first meal should be eaten in bed. It is helpful to keep crackers and water on the bedside table to eat before getting up. Avoid lying down immediately after meals. Try to eat before you become hungry, as an empty stomach can worsen nausea when eating. Cold, clear, carbonated drinks are often best tolerated, preferably in small amounts between meals. Ice pops can be a good way to maintain fluid intake. Heat, high humidity, loud noises, and car travel can also worsen nausea.

Most women follow up with their GP. Some will require repeated fluid treatment, which can be provided on an outpatient basis (without hospital admission). If this is insufficient, readmission to hospital may be necessary.

Sist faglig oppdatert 9/25/2024

Morning sickness

Common morning sickness

Severe morning sickness

Referral and assessment

Before

During

After

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Morning sickness

Information from Helsenorge

Common morning sickness

Severe morning sickness

Referral and assessment

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