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Complications

The effect of dehydration, vomiting and malnutrition can have knock on effects and lead to a number of associated symptoms. 

  • Constipation. A very common side effect of dehydration is constipation which can be severe, painful and distressing. Rehydration is important to deal with this. Once you are able to drink again, you can take fybogel, it's unpleasant but effective. In difficult cases lactulose, movicol, dulcolax or glycerin suppositories are helpful. Most over the counter remedies for constipation are safe to take in pregnancy, although you should probably check with your GP. For very severe symptoms, you may require an enema. The problem can be made worse by antiemetics, in particular constipation is a known side effect of ondansetron. Note also that if you are taking metoclopramide as an antiemetic, it can make your faeces more runny and this combined with the slow moving bowel caused by ondansetron can mean that nothing can move through the bowel. If you are beginning to suffer from constipation don't delay in addressing the problem, it is a condition which only gets worse as time goes on.
  • Headaches, cracked lips and mouth sores are other common side effects of dehydration. 
  • Repeated vomiting can cause tears in the gullet, called Mallory-Weiss tears which cause you to bring up fresh, red blood. If you bring up vomit that looks like coffee grounds you should seek immediate medical attention as this is old blood and can indicate a bleed further down. 
  • Acid reflux, which can lead to hiatus hernia is also fairly common. You doctor can prescribe an antacid if you can tolerate it. 
  • Low iron and vitamin levels can cause problems and should be checked if you have had an inadequate diet for a prolonged period. This can be difficult to treat as iron tablets are known to make nausea worse. Discuss with your doctor or midwife other ways to take iron.
  • Teeth may suffer from acid in vomit and bile. Moreover, many women find that they can't brush their teeth as it stimulates their gag reflex and makes them vomit. You may have to use a mouth wash and speak to your dentist. Make your dentist aware of the problem so that they can advise you and also so that they go easy during examinations so as not to trigger a vomit. One woman was advised not to brush her teeth within an hour of vomiting as you just brush it into your teeth, use mouthwash instead. Ask your doctor for a prescription for mouthwash to save you buying it as you may get through a lot of it.
  • Sleep disorders are common in HG. It seems particularly cruel that the only time you have relief from nausea is during sleep, and even though you are exhausted from starvation you still cannot drop off. Some women find that antiemetic medications that make you drowsy, such as phenergan, or cyclizine are helpful in this situation. 
  • Ptyalism (hyper salivation) can be caused by repeated vomiting. This is quite unpleasant and some women find that that swallowing their own saliva makes them vomit. It may be necessary to carry around a cup to spit into. 
  • Ante-natal depression, post natal depression (PND) and post traumatic stress disorder (PTND) are risks of HG. It is very difficult to keep your mood elevated when you are suffering the continual physical and emotional misery of HG. Treatment of the HG and relief of symptoms is probably the most effective way to avoid associated depression, but where this is not possible or treatment doesn't work, be aware that it is a very real risk and speak to your doctor about strategies to avoid it. Having had HG puts you at greater risk of PND, partly because of the greater difficulty you will have in coping with a newborn when your own reserves are so depleted. Be aware also that post traumatic stress disorder (PTSD) is a possibility. HG is an extremely traumatic condition and some women have flashbacks and nightmares. 


For more information about complications of HG see 

http://www.hyperemesis.org/mothers/about-hyperemesis/complications.php