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Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance.

Mild cases are treated with dietary changes, rest and antacids. More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line (IV). DO NOT take any medications to solve this problem without first consulting your health care provider. Why is this happening to me? Do not worry. Your body is not trying to reject the baby as some people used to think. The majority of pregnant women experience some type of morning sickness (70 - 80%). In about 1% of all pregnancies, the woman will experience extreme morning sickness called hyperemesis gravidarum. It is believed that nausea is caused by a rise in hormone levels; however, the absolute cause is still unknown. Hyperemesis gravidarum cannot be prevented, but you can take comfort in knowing that there are ways to manage it. Distinguishing between morning sickness and hyperemesis gravidarum: Morning Sickness: Hyperemesis Gravidarum: Nausea sometimes accompanied by vomiting Nausea accompanied by severe vomiting Nausea that subsides at 12 weeks or soon Nausea that does not subside after Vomiting that does not cause severe Vomiting that causes severe dehydration dehydration Vomiting that allows you to keep some food Vomiting that does not allow you to keep any food down down Signs and symptoms of hyperemesis gravidarum:

Severe nausea and vomiting Food aversions Weight loss of 5% or more of pre-pregnancy weight Decrease in urination Dehydration Headaches Confusion Fainting Jaundice

What are the treatments for hyperemesis gravidarum? In some cases hyperemesis gravidarum is so severe that hospitalization may be required. Hospital treatment may include some or all of the following:

Intravenous fluids (IV) to restore hydration, electrolytes, vitamins, and nutrients Tube feeding:

Nasogastric restores nutrients through a tube passing through the nose and to the stomach Percutaneous endoscopic gastrostomy restores nutrients through a tube passing through the abdomen and to the stomach; requires a surgical procedure

Medications metoclopramide, antihistamines, and antireflux medications*

Other treatments may include:

Bed Rest This may provide comfort, but be cautious and aware of the effects of muscle and weight loss due to too much bed rest. Acupressure The pressure point to reduce nausea is located at the middle of the inner wrist, three finger lengths away from the crease of the wrist, and between the two tendons. Locate and press firmly, one wrist at a time for three minutes. Seabands also help with acupressure and can be found at your local drug store. Herbs ginger or peppermint Homeopathic remedies are a non-toxic system of medicines. Do not try to self medicate with homeopathic methods; have a doctor prescribe the proper remedy and dose. Hypnosis

The amniotic fluid is part of the babys life support system . It protects your baby and aids in the development of muscles, limbs, lungs and the digestive system. Amniotic fluid is produced soon after the amniotic sac forms, about 12 days after conception. It is first made up of water that is provided by the mother. After about 20 weeks into the pregnancy, it is primarily made up of fetal urine. As the baby grows, he or she will move and tumble in the womb with the help of the amniotic fluid. In the second trimester the baby will begin to breathe and swallow the amniotic fluid. Amniotic fluid levels increase regularly until about 32-33 weeks gestation, and then they level off. In some cases the amniotic fluid may measure too low or too high. Normal fluid levels may vary, but are usually considered an AFI of 5-25 centimeters or a fluid level of about 800-1000 mL. If the measurement of amniotic fluid is too low it is called oligohydramnios . If the measurement of amniotic fluid is too high it is called polyhydramnios. What is Polyhydramnios? Polyhydramnios is the condition of having too much amniotic fluid. Doctors can measure the amount of fluid through a few different methods, most commonly through amniotic fluid index (AFI) evaluation or deep pocket measurements. If an AFI shows a fluid level of more than 25 centimeters (or above the 95th percentile), a single deep pocket measurement of <8, or a fluid level of 2000mL or more, then a diagnosis of polyhydramnios would be made. About 1-2% of pregnant women have too much amniotic fluid. Most of these cases are mild, with only slightly elevated levels. What causes levels of amniotic fluid to be elevated? Congenital defects The higher the fluid level, the increased chance of a congenital defect. These birth defects hinder swallowing, which can prohibit ingestion of the amniotic fluid, resulting in buildup of fluid. Other birth defects could also include intestinal tract blockage or neurological abnormalities. Rh factor As screening for the Rh factor has increased, this is no longer a common cause of elevated fluid levels. Maternal Diabetes Experts have found some correlation between diabetes and too much amniotic fluid. Twin-to-twin transfusion syndrome This is a complication that can affect identical twin pregnancies. This syndrome is when one baby gets too much blood flow and the other too little due to connections between blood vessels in their shared placenta. Unknown Reasons According to the Center for Maternal Fetal Medicine, about 65% of cases of polyhydramnios are due to unknown causes.

What are the risks of having too much amniotic fluid? Most cases of polyhydramnios are mild and result in few, if any, complications. Those with higher levels of fluid could experience one or more of the following risks:

Premature rupture of the membranes (PROM) Placental abruption Preterm labor and delivery (approximately 26%) Growth restriction (IUGR) resulting in skeletal malformations Stillbirth occurs in about 4 in 1000 pregnancies that suffer from polyhydramnios vs. about 2 in1000 pregnancies with normal fluid levels. Cesarean delivery Postpartum hemorrhage

What are the treatments for elevated amniotic fluid levels? Many cases of polyhydramnios are easily treated and do not result in complications if the pregnancy is monitored closely. Monitoring would include frequent sonograms measuring growth, biophysical profile and fetal assessment. Other treatments could include:

Medication that can reduce fluid production and are as much as 90% effective. This treatment is not used after 32 weeks gestation because of possible complications. Amnioreduction is a procedure that can be used to drain excess fluids. This is done through amniocentesis, which may carry certain risks. There is, however, the chance that fluid could build back up even after draining. Delivery of the baby