Abstract: Hyperemesis gravidarum or excessive vomiting of pregnancy is sufficient to cause complications for the mother as well as the fetus. Its pathogenesis is unclear and requires thorough evaluation. Apart from its general management by maintaining the hydration and electrolytes, homoeopathic medicines can remove these symptoms with utmost safety of the pregnant lady and the fetus.
Keywords: Hyperemesis gravidarum, Pregnancy, Morning sickness, Homoeopathy.
Next to cessation of menses, and in conjunction with it, morning sickness becomes one of the most reliable symptoms of pregnancy. But when this morning sickness increases exponentially, it can create complications too. Hyperemesis gravidarum is the medical term used for excessive vomiting of pregnancy.
Hyperemesis Gravidarum (HG) is defined as mild to severe relentless nausea and vomiting which is sufficient to cause dehydration, weight loss or other electrolytes imbalance in the body like hypokalemia. In its contrast, mild to moderate nausea and vomiting are common until approximately 16 weeks of pregnancy. According to International Statistical Classification of Disease and Related Health Problems, Tenth Revision, HG begins before the end of 22 weeks of gestation. The prevalence of hospitalization rate for HG has increased from 0.5-0.8% in 2006  to 0.3- 2.0% in 2014.
Etiopathogenesis of HS remains unclear and is multifactorial. Rise in serum levels of pregnancy hormones like human chorionic gonadotropin (hCG), estrogens, progesterone, leptin, placental growth hormone, prolactin, thyroxine and adrenocortical hormones are mostly implicated.  Raised level of estrogen and progesterone also lead to relaxation of lower esophageal sphincter which itself can cause nausea.
Other cause include interrelated psychological components and positive family history of HS.
Clinically, apart from nausea and vomiting the patient will present with increased salivation, epigastric tenderness, fatigue, weakness and dizziness which are common symptoms. Some rare symptoms may develop such as hyperolfaction, dysgeusia, decreased gustatory refinement, sleep irregularities, depression, anxiety, irritability and mood changes.
Diagnosis and Evaluation
HS is diagnosed clinically after excluding all other possible causes of severe nausea and vomiting during pregnancy such as gastroenteritis, achalasia, pyelonephritis, diabetic ketoacidosis, hyperthyroidism, migraine headaches, etc.
To evaluate the severity of HG and response to treatment, pregnancy unique quantification of emesis and nausea (PUQE) scoring index can be used.
HS can lead to potentially fatal complications if left untreated. Maternal complications include dehydration, vitamin deficiency, malnutrition, coagulopathy, Wernicke encephalopathy, pneumothorax and gastroesophageal rupture, diaphragmatic rupture due to forceful vomiting.[1,2]
Fetal complications include low birth weight, premature infants and fetal intracranial haemorrhage.[1,2]
Apart from controlling the bouts of vomiting, maintenance of hydration and electrolytes are one of the primary goals of management. Mild to moderate cases of HS can be managed with dietary modifications along with indicated medicine. Ginger extract, Vitamin B6 administration are particularly found effective. In severe cases intravenous correction of electrolytes as well as parenteral nutrition is required.
Homoeopathic management for Hyperemesis gravidarum
There are many homoeopathic medicines which are mentioned in the textbooks of homoeopathic materia medica for the vomiting of pregnancy. These medicines are prescribed on the basis of the law of ‘Similia Similibus Curantur’ which states that ‘like cures like’. So every individual pregnant female will get tailored individualized treatment according to her symptoms and disposition. Some of the commonly prescribed medicines for frequent vomitings of pregnancy are described below:
- Aletris farinosa– Vomiting of pregnancy. Disgust for food. Least food causes distress.
- Apomorphinum hypochloricum– Reflex vomiting of pregnancy . Vomiting is preceded by nausea, lassitude and increased secretion of sweat, saliva,mucus and tears.
- Carbolicum acidum– Vomiting of pregnancy. Excessive nausea, and inclination to vomit; while eating a little, after breakfast.
- Cucurbita pepo– Vomiting of pregnancy. Intense nausea immediately after eating.
- Gossypium herbaceum: For vomiting of pregnancy when the nausea is accompanied by accumulation of saliva in the mouth before breakfast. It is indicated when the vomiting is followed by faintness and prostration due to which the female will not be able to rise up from the bed. It is accompanied by great distress and weakness.
- Ipecacuanha- Vomiting of pregnancy. Constant nausea and vomiting with pale face, twitching of face, usually clean tongue.
- Jatropha- Vomiting of pregnant women. Easy vomiting of large quantities of watery, albuminous substances; at same time watery diarrhœa, with spasmodically contracting pains in the stomach, burning in the stomach, cramps in the calves; coldness of body; viscid sweat.
- Kreosotum- Vomiting of sweetish water in the morning; vomiting of food several hours after eating. Nausea. Sensation as if ice water in stomach.
- Lacticum acidum– Morning sickness especially in pale, anaemic women. Nausea is better when eating. Hot ,acrid eructations. Burning hot gas from stomach to throat which causes profuse mucus secretion.
- Nux vomica– Nausea in the morning ,after eating. Sour taste. Nausea and vomiting which are much retching. Wants to vomit, but cannot. Desire for stimulants, fats and tolerates them well.
- Phosphorus– The nausea of pregnancy is cured when the woman cannot put her hands into warm water without vomiting. Nausea especially in morning or in evening, or else after a meal. As soon as the water (or food) becomes warm in the stomach it is thrown up.
- Pulsatilla Pratensis– Morning sickness. Insupportable nausea and inclination to vomit, sometimes extending to throat and into mouth, with distressing sensation as of a worm crawling up œsophagus.
- Sepia officinalis– Nausea in the morning before eating. Disposition to vomit after eating. Nausea at sight or smell of food, worse lying on side.
- Symphoricarpus racemosa– Highly indicated for vomiting of pregnancy with fickle appetite, nausea, waterbrash, bitter taste, constipation. Nausea, worse any motion and better by lying on back. Aversion to all food.
- Tabacum– Vomiting during pregnancy with much spitting. Vomiting at least motion, sometimes of fecal matter. Incessant nausea, worse smell of tobacco smoke. Nausea, vomiting, giddiness, pallor, icy coldness and sweat with intermittent pulse are very characteristic remedies.
- Veratrum album– Vomiting of pregnancy. Vomiting, nausea and cold sweat accompanied by threatened abortion.
Discussion and Conclusion
Hyperemesis gravidarum is called the excessive vomiting of pregnancy. It has the potential to harm the mother as well as the foetus. As its prevalence is rising, it demands us to find better ways of management which do not possess any potential side-effects. Homeopathy is the perfect contender which offers a quick and safe treatment for the pregnant lady. There are many indicated homoeopathic medicines which can be prescribed for hyperemesis gravidarum such as Symphoricarpos racemosa, Aletris farinosa, etc.
- Cunningham F.G., Leveno KJ, Bloom S.L, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 24th Ed. 2014 McGraw-Hill Education USA pp 1070-1074
- McCarthy FP, Lutomski JE, Greene RA. Hyperemesis gravidarum: current perspectives. International Journal of Women’s Health. 2014 ;6:719-725. DOI: 10.2147/ijwh.s37685. PMID: 25125986; PMCID: PMC4130712.
- Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, Perju‑Dumbrava L. Life‑threatening complications of hyperemesis gravidarum. Experimental and therapeutic medicine. 2021 Jun 1;21(6):1-3. DOI:10.3892/etm.2021.10074 [Internet] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097228/
- Boericke W. Boericke’s New Manual of Homeopathic Materia Medica with Repertory. New Delhi: B.Jain Publishers (P) Ltd.; 2013.
- Clarke J.H. A Dictionary of Practical Materia Medica (Vol-I). New Delhi: B.Jain Publishers (P) Ltd.; 2015.
- Kent J.T. Lectures on Homoeopathic Materia Medica. New Delhi: B.Jain Publishers (P)Ltd.; 2013.
Dr. Priyanka Verma
MD Scholar, Department of Materia medica, Dr MPK Homoeopathic Medical College, Hospital and Research Centre, Homoeopathy University, Jaipur, Rajasthan.
Dr Kanika Agarwal
MD Scholar, Department of Practice of Medicine, Dr MPK Homoeopathic Medical College, Hospital and Research Centre, Homoeopathy University, Jaipur, Rajasthan.