• Simple vomiting
  
• Hyperemesis Gravidarum or severe vomiting
  

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Simple Vomiting (morning sickness):

There is nausea and occasional vomiting specially on rising in the morning. It could also be seen throughout the day. This is so common that it is considered as one of the symptoms of pregnancy. This does not restrict the normal activities of the woman. It usually disappears by 12 to 14 weeks of pregnancy. It is due to hormonal changes is the body due to pregnancy.

Treatment:

• Assurance is given to the woman, adviced to move the limbs before getting up from bed, eating dry food like toast or biscuit before getting out of bed, avoiding fried and spicy food. This is enough to relieve the symptoms. If these fail then antiemetic drugs can be taken after visiting a doctor.
• Plenty of fluid intake with glucose or fruit juices are of  help.

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Hyperemesis Gravidarum (severe vomiting)

It is a severe type of vomiting during pregnancy which has got an adverse effect on the health of the woman and/or incapacitates her in day to day activities.

The exact cause of it is not known. It is seen mostly in-

• First 12 weeks of pregnancy.
• Common in first pregnancy.
• Has family history.
• More in multiple pregnancies (twins etc) and Hydatidiform mole.
• Common in unplanned pregnancy. Although the excat cause is not known, it could be because of hormonal changes
• Psychological factors can be responssible
• Dietary deficiencies.
• Allergic to products secreted from ovum (egg).
• lmmunological basis- It causes metabolic, biochemical & circulatory changes in body and affects almost all organs.

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Clinical features:

• Early-
  • Only activities are restricted without evidence of dehydration and/or starvation. In this vomiting occurs independent of food intake, normal activities are curtailed. Nutrition does not suffer, patient looks well and blood, biochemistry & urinanalysis reveales no abnormalities.
• Late-
  • Evidence of dehydration & starvation are present. The colour of the vomitus may be coffee ground or blood stained. It may reach a stage where there is no urine formation. There may be constipation or diarrhoea and the patient is confined to the bed. There may be restlessness, sleeplessness, convulsions or even coma, diminished vision, increased temperature of the body and breath smelling of acetone.

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Management :

• Hospitalization of the woman.
• Correcting fluid imbalance by Intravenous fluids.
• Adequate sedatives are given.
• Antihistaminic and antiemeticdrugs can be used.
• Administer B- complex vitamins.
• Diet - Before stopping I.V. fluids start oral food. In case the vomiting is extremely severe and life threatening to the patient termination of pregnancy can be done but it is extremely rare.
  
  

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