Morning sickness pains

All Woman

DEAR DR MITCHELL,

I am eight weeks pregnant and having a difficult time with morning sickness. What can I do to minimise this? I got Gravol from my doctor but I can't even swallow the pills to make it work! Are there any solutions?

Vomiting in pregnancy is a fairly common problem, especially in the first trimester. This would be the early stage from when the menstrual period is missed, up to about 14 weeks' pregnancy. In most women this is mild and will be tolerated, but in some women it can become significantly severe, resulting in dehydration, weight loss and a need for hospitalisation.

Excessive vomiting in pregnancy tends to be seen more commonly in women who have multiple pregnancy. In situations where there is a molar pregnancy, this can also cause excessive vomiting. This is a condition where the placental tissue undergoes an abnormal development and a foetus is absent in most cases. If the foetus is present (partial mole) then it is usually abnormal. This pregnancy has to be terminated in all cases.

It is important to have a pelvic ultrasound early in the pregnancy to confirm the date of delivery, the number of foetuses present, and to rule out a molar pregnancy.

Vomiting in pregnancy can initially be managed by avoiding the foods that cause you to develop worsening of the nausea and vomiting, and constantly switching to foods that can be tolerated. The use of medications to control the vomiting can sometimes help. In some cases the vomiting worsens and tablets by mouth cannot be tolerated. In this situation the tablets can be inserted in the rectum (back passage) with good effect. If there is no resolution then the medication can be given by injections in the muscles or the veins to suppress the vomiting.

Gravol is usually a common first-line drug that is used with a good outcome. In cases where it does not work, then a switch to other safe drugs can be done with very good effect. In situations where the vomiting continues in spite of the medications, then admission to hospital is necessary to prevent dehydration and poor nutrition with associated weight loss. Replacement of fluids can be done by intravenous fluids and continued medications to prevent vomiting.

The addition of vitamin B supplements is usually done in women who vomit excessively to prevent medical complications that occur as a result of the depletion of vitamin B. There is usually gradual introduction of liquids by mouth and a bland diet to reduce the risk of recurrence of the vomiting. The use of ginger in teas and other drinks is usually very helpful in reducing the vomiting. Ginger teas, sweets, and biscuits are usually very helpful.

The good thing is that the vomiting usually resolves by 14 weeks and the outcome for your baby will be very good.

It is important to recognise the need to switch foods that reduce the nausea and vomiting at regular intervals.

Consult your doctor who will advise you further and get the care that you need.

Wishing for you a safe pregnancy and a successful delivery.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

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