Abstract:
Hyperemesis Gravidarum is a serious complication of pregnancy presenting as prolonged and severe nausea and vomiting causing dehydration, malnutrition and significant morbidity. Women with a history of hyperemesis Gravidarum have around 80%chance of suffering in subsequent pregnancies. Careful and thorough planning in future pregnancy can significantly reduce the overall severity of symptoms. This article explores the various aspects of thorough prophylactic homoeopathic medication to optimise the outcomes of future pregnancy and decrease the rate of morbidity associated with hyperemesis Gravidarum.
KEYWORDS:
Hyperemesis Gravidarum, Nausea, Vomiting, Antiemetic, Homoeopathic medicine.
INTRODUCTION:
Hyperemesis Gravidarum is a severe and potentially life-threatening condition, which can have profound effects on the mother’s health and wellbeing. Nausea and vomiting affect around 80-85%of pregnant women to a greater or lesser degree making it the most common medical condition in pregnancy. Around 30%of women will be severely affected, however, only 1-15%of pregnant women will be admitted to hospital with extreme nausea and vomiting, known as Hyperemesis Gravidarum.
DEFINITION:
It is a severe type of vomiting of pregnancy which has got a deleterious effect on the health of mother such as weight loss, dehydration, acidosis, and alkalosis occurs from starvation.
HIGH-RISK FACTORS:
– Unknown
– More common in the first pregnancy
– Multiple pregnancies
– Age >30years
– Nulliparity
– Maternal obesity
– Low body mass
– Unplanned pregnancy
– Younger age
– Hydatidiform mole
– Family history [ Mother, sister]
– Migraine, Morning sickness
Nausea and vomiting of pregnancy affect the women which interfering with the performance of his daily activities, disrupting family life and causing time loss from work. Intractable nausea and vomiting leading to fluid, electrolytes, acid-base imbalance, nutrition deficiency, and weight loss during early pregnancy.
Clinically manifested by persistent more than three episodes of vomiting per day, weight loss of more than3 kg or, 5% of weight loss, Ketonuria, electrolyte abnormalities, hypokalemia, dehydration.
PATHOPHYSIOLOGY:
Hormonal imbalance: an excess of chorionic gonadotropin or, hCG
: High serum level of oestrogen
: Excess Progesterone
: Thyroxine, prolactin, leptin, and Adrenocorticoid hormones.
There are no specific morbid anatomical findings, changes in various organs as described below.
Liver – small fatty infiltration
Kidney – fatty degeneration of convoluted tubules.
Heart- small subendocardial and sub pericardial haemorrhage.
Brain – congestion, petechial haemorrhages.
Eyes – optic neuritis, retinal haemorrhage.
Nerves – starvation
INVESTIGATION:
CBC
Urine Analysis
Serum Electrolytes [sodium, potassium, chloride]
Liver Function Test
Thyroid Function Test [serum TSH, T3, T4]
Ultrasound Scan
Ophthalmoscopic Examination
ECG
DIAGNOSIS:
Pregnancy is to be confirmed first.
– Gynaecological: Twisted ovarian tumour, Red degeneration of fibroid
– Surgical: Peptic ulcer, Appendicitis, Cholecystitis, Pancreatitis, Intestinal obstruction.
– Medical: Urinary Tract Infection, Hepatitis, Ketoacidosis of diabetes, Pyelonephritis, Intestinal infestation, Uremia.
COMPLICATION:
Maternal side:
Majority of complaints due to dehydration, and starvation which result in ketoacidosis.
– Jaundice
– Stress Ulcer in the stomach
– Oesophageal Tear
– Vit.K deficiency
– Wernicke’s encephalopathy, pontine myelinolysis, peripheral neuritis.
Fetal side:
– Low birth weight
– Preterm birth
MANAGEMENT:
– Maintenance of hydration
– To correct the fluids and electrolytes imbalance
– To correct metabolic disturbances
– To avoid fatty food and strong odorous food which trigger nausea and vomiting.
– To control vomiting
– Care of pregnant women
– DRUGS: ANTIEMETIC DRUGS: Promethazine 25mg, Metoclopramide,
– Hydrocortisone 100mg IV in the drip. Vit. B1, B6, B12, C.
– HOMOEOPATHIC MANAGEMENT:
– Arsenicum album, Carbolic Acid, Cocculus, Graphites, Kreosote, Ipecacuanha, Natrum Mur, Nux vomica, Pulsatilla , Phosphorous,
Sepia, Thalapsi bursa, Veratrum album, etc.
1) Arsenicum album:
Cannot bear the sight or smell of food
Nausea, retching, vomiting after eating or drinking
Vomiting of blood, bile, green mucus, brown-black mixed with blood
Anxiety in the pit of the stomach
Craves acids and coffee
Mentally, very anxious and fearful
Aggravation: Cold food, cold drinks, mid-day
Amelioration: Warm drinks, warmth in general, raising the head
2) CARBOLIC ACID:
Excessive vomiting in the early months of pregnancy
Vomit contains undigested food material, foul-smelling liquid
Vomitus; dark, olive green, offensive
Constant belching, nausea, vomiting
Mental; does not like any mental work
Aggravation: while walking, mental exertion
Amelioration: Smoking, strong tea, rubbing
3) FERRUM METALICUM
Nausea and vomiting immediately after eating
Spits up food by the mouthful
Heat and burning in stomach
Attempts to eat bring on diarrhoea
The desire for sour things
Irritable lady, slight noises unbearable
Aggravation: Rest, Mid-night, sweating
Amelioration: Walking slowly, warm
4) PHOSPHORUS:
Vomiting, water is thrown up as soon as it gets warm in stomach
Throws up ingesta by the mouthfuls
Post-operative vomiting
A very weak, empty, all-gone sensation felt in the whole abdomen
The desire for salts, cold drinks, ice
Desire to be Magnetized
Aggravation: warm food, drink, lying on Lt .side
Amelioration: Rt .side, Dark, cold things
5) SEPIA
Nausea in the morning before eating
Nausea with bulky, curd-like vomitus in morning
Nausea at smell or sight of food
Rumbling and gurgling in the abdomen with profuse vomiting in the first trimester makes lady too weak
Indifferent to those loved best
Aggravation: forenoon, evenings, Lt. side, cold air
Amelioration: exercise, pressure, drawing limbs up
6) COCCULUS INDICUS
Nausea from riding in cars, looking boat in motion
Sensation as if one had been a long time without food until hunger was gone
Nausea, with faintness and vomiting
She cannot bear any contraindication
Aggravation: sleep, motion, eating
7) IPECACUANHA
Constant nausea and vomiting
Vomits food, bile, blood, mucus
Stomach feels relaxed as if hanging down
Very irritable takes everything is bad parts
Aggravation: every winter, rest
8) NUX VOMICA
Nausea and vomiting, with much retching
Sour taste, and nausea in the morning, after eating
Wants to vomit, but cannot
Very irritable, sensitive to all impression
Aggravation: morning, after eating, spices
Amelioration: rest, strong pressure
9) GRAPHITES
Nausea and vomiting after each meal
Sweets nauseate
Aversion to meat
Morning sickness during menstruation
Aggravation: at night, warmth
Amelioration: wrapping up, in dark
10) KREOSOTUM
Nausea; vomiting of food several hours after eating
Sweetish water in the morning
Feeling of coldness, as of ice water in the stomach
Greenish vomitus, offensive
Aggravation: in the open air, when lying, rest
CONCLUSION:
Hyperemesis Gravidarum has been found as an important risk factor for morbidity during pregnancy. Despite treatment in other system hyperemesis Gravidarum remain suboptimally controlled. Homoeopathic treatment is the most appropriate, beneficial and effectively utilised within the health system as this could improve care whilst reducing the symptoms as well mental well-being of the patient.
References:
1) Hiralal Konar, DC Dutta’s Textbook of OBSTETRICS, 9THEdition, Jaypee Brothers Medical Publishers Ltd.
2) Ten Teachers, OBSTETRICS, 20TH Edition, edited by LOUISE C KENNY and JENNY E MYERS.
3) Intervention for nausea and vomiting in early pregnancy.
Matthews A, et al. Cochrane Database Syst Rev. 2015.PMID:26348534
4) Royal College of Obstetricians and Gynaecologist. The management of nausea and vomiting of pregnancy and hyperemesis Gravidarum(Green-TOP Guideline 69) LONDON: RCOG; 2016
5) Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in
Pregnancy A Systematic Review and Economic Assessment.
Amy O’Donnell et al. Health Technol Assess.2016 OCT
6) British Journal of Midwifery22 (12):847-852.December 2014
7) O’Donnell A, McParlin C, Robson SC, et al. treatment for hyperemesis
Gravidarum and nausea, vomiting in pregnancy: health techno assesses.2016; 20(74):1-268.
8) WILLIAM BOERICKE, M.D. POCKET MANUAL OF HOMOEOPATHIC MATERIA
MEDICA AND REPERTORY COMPRISING OF THE CHARACTERISTIC AND GUIDING
SYMPTOMS OF ALL REMEDIES INCLUDING INDIAN DRUGS.2002 EDITION, 15TH
IMPRESSION: 2018 B.JAIN.PUBLISHERS.LTD.
9) LECTURES ON HOMOEOPATHIC MATERIA MEDICA TOGETHER WITH KENT’S NEW REMEDIES INCORPORATED AND ARRANGED IN ALPHABETICAL ORDER BY JAMES.TYLER. KENT. 17TH IMPRESSION 2018, Introduce by DR.JUGAL KISHORE.B.JAIN.PUBLISHERS.
10) KEYNOTES REARRANGED AND CLASSIFIED WITH LEADING REMEDIES OF THE MATERIA MEDICA and BOWEL NOSODES including Repertorial Index, By H.C.ALLEN, M.D.,10TH Edition, B. Jain Publishers
11) GYNAECOLOGY AND OBSTETRICS THERAPEUTICS By DR.SHRIKANT KULKARNI, reprint edition, 2008, B. Jain. Publishers.
AUTHOR: AKANKSHA J VYAS
From, Parul Institute of Homoeopathy and Research, Parul University.
Guided by: DR. BHAVITA MALVI
