Common problems arising during pregnancy, (include) dizzy spells and fainting, nausea and hypermesis gravidarum

During pregnancy, one can feel a spell of dizziness or sense of fainting anytime during the day.

This is mainly because of iron deficiency.

Normally during pregnancy, hemoglobin level gets down. If is not corrected by adding iron preparation, the level further falls. As hemoglobin carries much needed oxygen, and its deficiency causes lack of oxygen in the brain, the person may feel dizziness.

Treatment is adequate rest, iron preparation.

Nausea and Hyperemesis gravidarum

Nausea is common in pregnancy. Especially in first time mothers. Morning time nausea is mostly seen (Morning sickness).

Increase level of the hormone estrogen and hCG is the main culprit of nausea. As the duration of pregnancy increases, feeling of nausea decreases.

Hyperemesis gravidarum

This is severe bouts of vomiting in pregnancy particularly during early period causing deleterious effect on mother’s health. Weight loss, dehydration, acidosis occur from starvation.

Incidence- 1 in 1000 pregnancies.

Causes- unknown. Factors considered responsible are- 1. Nurosis, 2. Hormonal flood of hCG and estrogen during early pregnancy triggers Vomiting center in the brain.

Symptoms-

First time mothers are more affected. Excess vomiting and retching day and night. Vomitus is initially watery, then billous, coffee ground. Nothing can be taken by mouth. Loss of weight. Markedly less output of urine (Oliguria). Infrequently mental symptoms like restlessness, lack of sleep, disinterest to everything (apathy), coma, confusion with loss of memory. Eye symptoms like- double vision, dimness of vision or even blindness.

Signs-

Patient is emaciated and dehydrated (loss of weight, shrunken eyes, dry tongue, increased pulse rate.

Blood pressure falls below 100 mm of Hg (Systolic).

Temperature rises above 100·4° F (38°C).

Jaundice seldom appears. Neurological signs may appear.

Investigations-

Urinalysis- Volume small, high colored, high specific gravity. Protein, bile pigment, acetone appear in the urine.

Urine Chloride falls or absent.

Blood- Hb% hematocrit rises, Serum SGOT & SGPT rise. Urea, Creatinine rise. Fall in Sodium, Potassium, Chloride, Bicaarbonate.

Ophthalmoscopy- Papilledema, Retinal hemorrhage are serious lesions. ECG changes occur due to Potassium deficiency.

Diagnosis- Clinical.

Management-

Prevention- to treat early stage by antiemetics to prevent severe form with morbid changes.

Curative- 1. Isolation. Mild cases improves by changes in place only. Severe case is to hospitalized.

2. Diet- if patient can be able to intake food, in milder cases plenty of carbohydrate rich diet is advised.

But in severe cases nothing per mouth is advocated. Intravenous fluids in the form of 5% dextrose and Ringers lactate is prescribed to correct dehydration.

Among other drugs are Promethazine (Phenergan), Chlorpromazine (Thorazine). Injection of Vitamin B1 is also introduced.