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Wednesday, 28 September 2011

Hyperemesis Gravidarum Pregnancy Two: Part One - Descent into sickness

Since I was so ill in my first pregnancy (too ill to look after myself let alone a baby or toddler) we felt we needed to allow a large age gap before another pregnancy in case I was ill again and A was 3 1/2 when I next had hyperemesis gravidarum.  In some ways I was relieved when I realised it was a hyperemesis pregnancy as I had recently had miscarriages of non-hyperemesis pregnancies and the sickness made me feel more confident of a good outcome.  (In my first pregnancy the doctors kept telling me that the good news about having bad sickness was a much lower risk of miscarriage but at the time when you are that sick you don't really care.)

In the intervening years since my first pregnancy I had forgotten how bad it was.  In some ways the actual sickness is not the worst thing.  The worst thing is that people do not believe how bad it is.  I had people say that they were able to carry on working during pregnancy because they just had to keep going even though they felt sick.  As if I could keep going but was just choosing not to.  Many people who have only had morning sickness seem to think that the reason you are ill is because nobody has told you that you just need to eat ginger or eat before you get up in the morning or eat crackers or whatever it was that helped ease their much milder sickness/nausea.

As a result I actually started looking into how serious hyperemesis gravidarum is.  Until the introduction of intravenous rehydration in the 1940's it was actually the leading cause of death in pregnancy:

"Hyperemesis gravidarum was a significant cause of maternal death before 1940. In Great Britain, mortality decreased from 159 deaths per million births from 1931-1940 to 3 deaths per million births from 1951-1960. Charlotte Brontë is thought to have died of hyperemesis gravidarum in 1855. In the United States, 7 deaths from hyperemesis gravidarum were reported in the 1930s. Today, although hyperemesis gravidarum is still associated with significant morbidity, it is still a rare cause of maternal mortality.
...
Hyperemesis gravidarum is a debilitating illness that can cause severe suffering, which profoundly affects both patients and their families. In about half of the women there is an adverse effect on spousal relationships, and 55% have feelings of depression. In one study of 140 women with hyperemesis gravidarum, 27% required multiple hospitalizations.
(from http://emedicine.medscape.com/article/254751-overview ).

It was only at this point that I realised that without the IV fluids, it is quite possible that I might have died in my first pregnancy.

I saw my GP for an anti emetic but within a week I went back because I was being so sick.  Unfortunately whilst not easing enough for me to not be losing weight my sickness did vary enough that when I saw him I was not ketotic so he sent me home with a different anti emetic and told me to come back if I got worse and that if I became ketotic he would refer me to the hospital.

The rest of that day (Monday) I wasn't sick but the following day I started being sick again and when I checked in the afternoon I was ketotic so I asked J to book me a doctors appointment for first thing Wednesday morning.  As the evening progressed I realised that I needed to be admitted to hospital for IV fluids so J phoned the out of hours service.  The doctor he spoke to said that he should bring me in and if I tested positive for ketones he would have me admitted to hospital.  Unfortunately by the time we got there (after J had packed me a hospital bag and got A up and ready to go out) there had been a shift change and the doctor who saw me seemed to think the best possible thing was to keep me out of hospital for as long as possible and gave me a buccal version of the anti emetic I already had.  This did make me well enough to take a few sips of water overnight and the following morning I saw my GP who promptly referred me for hospital admission.

The previous time I had been in hospital for three days and had improved fairly quickly so since I had managed to control the sickness better (due to experience) and had only lost five pounds by the time I was admitted I was fairly optimistic that I would soon be improved and thought I may only be in for two days which would have allowed me to be home before Christmas Day.  Unfortunately this was not to be.

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