Morning Sickness

　　For any woman, pregnancy is a major event, and it is also a happy and joyful thing, but women after pregnancy need to face many problems; among them, morning sickness is a problem that all women will encounter. Many pregnant women want to know what causes morning sickness? Below, experts introduce the causes of morning sickness:

　　One: Endocrine Factors

　　1. Chorionic Gonadotropin (HCG) Level Increase: It is now believed that severe morning sickness is related to a sharp increase in HCG levels in pregnant women's blood. Because on the one hand, the onset and disappearance of early pregnancy reactions correspond to the increase in HCG levels in pregnant women's blood; on the other hand, the HCG values in patients with multiple pregnancies and hydatidiform mole are significantly increased, and the incidence of severe morning sickness is also increased. After termination of pregnancy, vomiting disappears. However, the severity of the condition is not necessarily positively correlated with the level of HCG in the blood.

　　2. Thyroid Function Changes: 60% of patients with severe morning sickness have transient hyperthyroidism. The increase in thyroid hormone levels is due to the stimulation of thyroid secretion by the increase in HCG concentration on the one hand; on the other hand, the thyroid secretes a conformational variant of HCG, which further stimulates thyroid activity. The severity of vomiting is significantly related to the levels of free thyroid hormone and thyroid-stimulating hormone.

　　Two: Mental and Social Factors

　　Pregnant women who are afraid of pregnancy, are mentally tense, unstable in emotions, have a strong dependence, and have a low social status and poor economic conditions are prone to severe morning sickness.

　　Three: Neurological Factors

　　On the one hand, the excitability of the cerebral cortex increases and the inhibitory activity of the subcortical centers decreases in the early stage of pregnancy, leading to various autonomous nervous functions in the hypothalamus being disordered, causing severe morning sickness. On the other hand, the uterus increases in size with the passage of pregnancy months, and the uterine receptors are stimulated, leading to a radiative reaction in the central nervous system, causing nausea and vomiting.

　　Four, other factors

　　1, Vitamin deficiency: Particularly, a deficiency of vitamin B6 can lead to severe vomiting of pregnancy.

　   2, Increased Helicobacter pylori: Compared with asymptomatic pregnant women, the serum IgG concentration of Helicobacter pylori antibodies in patients with severe vomiting is elevated.

　　In summary, it is these reasons introduced above that lead to severe vomiting in pregnant women. If the vomiting is mild and does not affect the normal eating and living of women, it will generally disappear gradually with the advancement of pregnancy. If it is severe enough to cause eating disorders, it is necessary to seek medical attention and examination in a timely manner to avoid affecting the development of the fetus.

　　Vomiting of pregnancy refers to the frequent occurrence of anorexia, mild nausea and vomiting, and dizziness in pregnant women during the early stages of pregnancy, known as early pregnancy reactions. Generally, these reactions start around 40 days after the cessation of menstruation and disappear within 12 weeks of pregnancy, having little impact on daily life and work, and no special treatment is required. So, what are the complications of vomiting of pregnancy? The following experts introduce the complications of vomiting of pregnancy:

　　Severe vomiting can cause esophageal rupture, with mucosal lacerations and bleeding at the junction of the esophagus and stomach (Mammary-Weiss syndrome). This usually occurs after severe vomiting, with most people believing that vomiting causes reflex contraction of the pyloric sphincter and intense contraction of the gastric antrum, combined with the contraction of the diaphragm and abdominal muscles, causing the contents of the stomach to exert a great impact and high pressure on the area around the cardia and the junction of the esophagus. At the same time, due to the spasm and contraction of the esophagus, its distal end may appear locally distended. When the intragastric pressure reaches 13-20 kPa, it can cause mucosal tearing. Since the mucosa cannot expand like the muscular layer, this causes mucosal tearing at the junction of the esophagus and stomach. In addition to the above mechanical reasons, local gastric mucosal lesions are also a major internal cause of the disease. Gastritis caused by various reasons can cause the mucosa to become brittle, weaken resistance, and easily cause lacerations of the cardia mucosa. Abdominal pain often occurs during or after vomiting, with severe upper abdominal pain, which is relatively fixed and cannot be relieved by analgesics; the amount of hematemesis mainly depends on the size of the mucosal laceration and the size of the involved vessels, and black stools may appear. In severe cases, it can lead to hemorrhagic shock, even death.

　　Severe vomiting during pregnancy often leads to transient hyperthyroidism, and in severe cases, it can cause life-threatening complications.

　　Serious deficiency of vitamin B1 can trigger Wernick's encephalopathy during pregnancy, leading to punctate hemorrhages in the gray matter surrounding the mesencephalon and cerebral aqueduct, cell necrosis, and gliosis. The cerebellum, thalamus, hypothalamus, and mammillary body may also experience punctate hemorrhages and necrosis. Approximately 10% of patients with severe vomiting have this condition, which is characterized by ophthalmoplegia, trunk ataxia, and amnestic psychiatric symptoms. Clinical manifestations include nystagmus, visual impairment, affected gait and standing posture, and in some cases, rigidity or coma. The mortality rate for patients with this disease after treatment is 10%, while the mortality rate for untreated patients is as high as 50%, often due to pulmonary edema and respiratory muscle paralysis.

　　4. Other symptoms include retinal hemorrhage, liver and kidney function damage, etc.

　　5. For the fetus, it can lead to restricted fetal growth and even intrauterine fetal death.

　　When women are pregnant, they will pay great attention to this. Pregnancy vomiting is an unavoidable phenomenon for many pregnant women. However, some people do not know they are pregnant when they experience vomiting. The following experts introduce the symptoms of pregnancy vomiting:

　　1. Nausea and vomiting

　　Nausea, drooling, and vomiting occur around 6 weeks of amenorrhea and gradually worsen with pregnancy, developing into frequent vomiting and inability to eat around 8 weeks of amenorrhea. The vomit contains bile or coffee-like secretions.

　　2. Disruption of water and electrolytes

　　Severe vomiting and long-term hunger can lead to dehydration and electrolyte imbalance, causing a large loss of hydrogen, sodium, and potassium ions, resulting in hypokalemia. Patients may experience significant weight loss, extreme fatigue, dry lips, dry skin, sunken eyes, reduced urine output, and weight loss due to insufficient nutritional intake.

　　3. Imbalance of acid and alkali

　　In a state of hunger, the body mobilizes the energy supplied by fat tissue, causing the intermediate products of fat metabolism - ketone bodies to accumulate, leading to metabolic acidosis.

　　That's all the symptoms of pregnancy vomiting introduced by the experts. It is hoped that this can serve as a reminder for some women who know little about this, and not to think that they have eaten something wrong when they experience pregnancy vomiting. It is also hoped that every woman can better take care of herself and be responsible for herself and her child.

　　Pregnancy vomiting can cause symptoms such as nausea and vomiting. Severe pregnancy vomiting can lead to rapid weight loss. In this way, the pregnant woman's nutrition may not keep up. So, can pregnancy vomiting be prevented? The following experts introduce the preventive measures for pregnancy vomiting.

　　1. Have a correct understanding of pregnancy and early pregnancy reactions. Pregnancy is a normal physiological process, and slight nausea and vomiting in the early stages of pregnancy are normal reactions that can disappear soon. There should be no heavy psychological burden, and maintain emotional stability and comfort.

　　2. Reduce triggering factors such as the stimulation of smoking, alcohol, and kitchen fumes. Try to keep the living environment clean, quiet, and comfortable. Avoid the smell of paints, coatings, pesticides, and other chemicals. After vomiting, clear the vomit immediately to avoid severe stimulation and rinse the mouth with warm water to maintain oral hygiene.

　　3. Pay attention to food hygiene. In addition to focusing on nutrition and easy digestion, avoid eating unclean, decayed, or expired food to prevent damage to the gastrointestinal tract.

　　4. Maintain smooth defecation. Constipation is common after pregnancy, so it is recommended to drink more water or dilute honey with cool boiled water. It is also advisable to consume fresh vegetables and fruits such as oranges, bananas, watermelons, fresh pears, and sugarcane.

　　Pregnancy-induced vomiting can lead to water and electrolyte imbalance and acid-base imbalance. It also has a significant impact on the fetus, which may lead to restricted fetal growth and even intrauterine fetal death. Therefore, this issue of pregnancy-induced vomiting should not be ignored.

　　Pregnancy-induced vomiting refers to frequent selective eating, decreased appetite, mild nausea and vomiting, dizziness, and fatigue in pregnant women during the early pregnancy period, known as early pregnancy reactions. Generally, these reactions start around 40 days after the last menstrual period and subside within 12 weeks of pregnancy, having little impact on daily life and work, and no special treatment is needed. So, what tests are needed for pregnancy-induced vomiting? The following experts introduce the laboratory tests needed for pregnancy-induced vomiting.

　　1. Urine test:Patients may have increased urine specific gravity, positive urine ketones, and protein and casts in the urine when kidney function is impaired.

　　2. Blood test:Blood concentration, increased red blood cell count, elevated hematocrit, and increased hemoglobin levels; blood ketone bodies may be positive, and carbon dioxide binding power may decrease; when liver and kidney function are impaired, blood bilirubin, transaminases, creatinine, and blood urea nitrogen levels may increase.

　　3. Fundus examination:Severe cases may present with retinal hemorrhage.

　　4. Electrocardiogram examination:Hypokalemia can cause changes in heart rhythm and myocardial damage, manifested as abnormal electrocardiogram findings.

　　Pregnant women with pregnancy-induced vomiting should choose light and easily digestible foods in terms of food structure, such as fresh vegetables, fruits, rice gruel, congee, soy milk, etc. Pregnant women should avoid greasy foods and overly sweet foods. Overly sweet foods are particularly prone to produce dampness and phlegm in people with weak spleen and stomach, leading to fetus Qi with phlegm and dampness ascending and causing nausea and vomiting. Foods such as candies, chocolates, honey, sucrose, and various candied fruits (such as dried apple, dried peach, etc.) all have the adverse effect of promoting dampness, so they should be avoided as much as possible.

　　Vomiting can affect appetite and eating, but pregnancy also requires more nutrition. Therefore, one should try to eat in order to provide enough nutrition for their body, such as eating during times when vomiting is less likely; choosing favorite foods, eating small and frequent meals; eating more vegetables, fruits, and other foods rich in vitamins; eating light and nutritious foods, such as various meat broths, etc.; high-fat foods should be avoided. Additionally, due to the smell of cooking being prone to诱发 and exacerbate vomiting, patients should try to avoid it before they recover. At the same time, they should drink more water to replenish the water lost due to vomiting.

　　The treatment principle for pregnancy-induced vomiting is hospitalization for rest, appropriate fasting, recording fluid intake and output, correcting dehydration, acidosis, and electrolyte imbalance, supplementing nutrition, and preventing complications. The following experts introduce the treatment methods for pregnancy-induced vomiting.

　　1. Fluid replacement therapy

　　Glucose infusion, glucose saline, normal saline, and balanced solution totaling about 3000ml should be administered intravenously daily, with 100mg of vitamin B6 and 2-3g of vitamin C added. To maintain a daily urine output of ≥1000ml, intramuscular injection of vitamin B1 should be given. To better utilize the infused glucose, insulin can be appropriately administered. Parenteral nutrition can be provided to patients with severe vomiting.

　　2. Antiemetic and Sedative Treatment

　　Chlorpromazine injection can be used, 25mg per day, for 1 to 2 days. Drugs such as metoclopramide can also be used. Initially, intravenous or rectal administration should be given, and after symptoms are relieved, oral administration should be changed. Ginger can also alleviate or eliminate symptoms without side effects.

　　3. Correction of Electrolyte Imbalance

　　Appropriate sodium supplementation should be given to those with sodium deficiency. While supplementing fluids, potassium should also be supplemented, with a general daily dose of 3 to 4g. In cases of severe hypokalemia, 6 to 8g of potassium should be supplemented, and attention should be paid to the amount of urine, monitoring serum potassium and electrocardiogram changes, and adjusting the dose in real-time.

　　Sodium supplementation amount (mmol/L) = body weight (kg) × 0.6 × (140 - measured blood sodium concentration mmol/L) Potassium supplementation amount (mmol/L) = body weight (kg) × 0.4 × (normal serum potassium - measured serum potassium) 4. Correction of metabolic acidosis should be based on the blood carbon dioxide value, and appropriate amounts of sodium bicarbonate or sodium lactate solution should be supplemented, with a common dosage of 125 to 250 ml. In severe cases, the following formula should be used to supplement alkali, with the initial dose usually being one-third of the total amount to be supplemented, and whether to continue supplementation should be decided after re-examination of the carbon dioxide binding capacity.

　　The amount of sodium bicarbonate to be supplemented (ml) = (23 - measured carbon dioxide binding capacity value mmol/L) × body weight (kg) × 0.5. The amount of sodium lactate to be supplemented (ml) = (23 - measured carbon dioxide binding capacity value mmol/L) × body weight (kg) × 1.85. Medical staff and patient families should provide psychological support to patients. The patient's surrounding environment should avoid odors that stimulate vomiting. Avoiding feeding the patient with food they do not want to eat can trigger vomiting. After 2 to 3 days of treatment as described above, the patient's condition usually improves rapidly, vomiting stops, the patient wants to eat, urine output increases, urine ketones become negative, and at this time, it is encouraged to feed the patient with a small amount of liquid food, eat more and less meals, and gradually increase the amount of food as the condition improves. If the amount of water and food intake is insufficient every day, appropriate fluid supplementation should still be made. A few patients may experience recurrence of symptoms after discharge, in which case they need to be readmitted.