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Nausea and vomiting in pregnancy

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The Duchess of Cambridge [previously Kate Middleton] has been in hospital because of hyperemesis  – nausea and vomiting leading to dehydration in pregnancy. Nausea and vomiting is common in early pregnancy but it is unusual for it to lead to dehydration [hyperemesis].

  Morning sickness is a misnomer as it occurs at any time of day and is often present all day long. Vomiting rarely eases the nausea unlike in gastro intestinal infections. The exact cause is not known but it is thought that high levels of HCG [secreted by the blastocyst/embryo to maintain the corpus luteum until the placenta is formed] play a role. This is thought to be why nausea and vomiting are more common in twin pregnancies and tends to improve when HCG levels fall. It is often disabling and in a few cases extreme dehydration can be life threatening. Charlotte Bronte who wrote ‘Jane Eyre’ died in 1855 while four months pregnant, having had nausea and vomiting since the start of her pregnancy, and was unable to stomach food or even water.

Drugs are usually given as a last resort. Thalidomide was given to women for pregnancy nausea and sickness 50 years ago. This led to the biggest medical disaster in the last century.  At that time it was thought that drugs did not cross the placental barrier and were not passed to the foetus. Thousands of pregnant women took the drug which caused phocomelia – a condition in which limb development fails. Estimates of the number affected range from 10,000 to 20,000. There are varying degrees of severity – in the most severe hands and feet are directly attached to shoulders or hips with no intervening limb. The number of limbs affected also varies. Victims are of normal intelligence. [see previous post on 50th anniversary of Thalidomide 1/9/12]

Sickness in pregnancy occurs in the early stages, the first 12 weeks of pregnancy. This is when development of the foetus occurs, and by 12 weeks the organs in a foetus are virtually fully formed and it mainly just grows in size for the remainder of the pregnancy. Thalidomide therefore had devastating consequences as it was marketed for nausea which occurs in early pregnancy.

Since Thalidomide, doctors, patients and drug companies have been extremely wary about prescribing drugs to pregnant or breast feeding women who have therefore probably been deprived of many effective treatments for a range of conditions. Earlier this year an article in the BMJ called for more research into this area.

Lastly the sad case of Jacintha Saldanha,  the nurse who was duped by a radio station’s call to the King Edward VII hospital, who was found dead in staff accommodation nearby on Friday demonstrates how important confidentiality is viewed in the medical profession.  The nurse had been suspended pending an investigation.

Breaking confidentiality can be a reason for immediate dismissal. Confidentiality has to to be respected even by medical students and those doing work experience!

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