Wife struggling hyperemesis gravidarum

[keldog]

Morning Dads!

Expecting my first child in March 2022, wife is currently 11 weeks. She was suffering really badly with morning sickness and a few weeks ago was diagnosed with hyperemesis gravidarum. They took her into hospital for a few hours last week to put her on an IV drip, as she was dehydrated. They gave her an anti-sickness injection while she was in and she felt much better...for a day or two. The sickness came back and she is heading back towards the same state she was in last week, struggling to keep any food down and very little fluids. They wont take her into hospital again until she has ketones in her urine, which at the minute she only has trace amounts of.

It seems like there isn't really any help for her from the GP/midwife/hospital until she is a really bad way. The constant feeling that she is going to throw up at any moment, combined with actually throwing up as soon as anything hits her stomach is really getting her down, she has been crying on and off all morning and I feel like there is nothing I can do to help.

Any advice on what I can do to support her?

What medication have you got? Cyclizine etc?

@torchh

What medication have you got? Cyclizine etc?

Yes, she has been prescribed Cyclizine, but they moved her onto Prochlorperazine (Buccal) and Metropramide. She is actually on her last few Metoclopramide and the midwife has advised putting her back on Cyclizine again. So I am heading down to pick the prescription up this afternoon...but in all honsetly, none of them really seem to do much. The Prochlorperazine basically knocks her out, so she sleeps a few times during the day after taking that one, which helps a bit. Doctor put her on 4 weeks sick leave, so she is off work for another 2 weeks or so.

I was this way back in April, I was so unwell , none of the anti sickness medication worked for me either. The only thing I found that helped was eating little and often, making sure my stomach was never empty , taking rehydration sachets and a tablet for acid reflux. I gave myself whiplash from vomiting so much but from about 14 weeks it started to ease and I'm 27 weeks now and I only feel sick if I eat too much.

It's horrible, I had severe HG with both pregnancies requiring hospital admissions.

The best anti emetic was Ondansetron, but they don't like to prescribe it as its so much more costly than cyclizine/metaclopamide. My first pregnancy I just about survived taking both metaclopamide and cyclizine, my second I got Ondansetron which was a life changer.

Could you go to a pharmacy and get her some urine dip sticks? Whenever her ketones reach 3 or 4 she needs to go back into hospital to be put on a drip.

Keep an eye on her weight, I think I lost 15% of my body weight between week 6 to 12.

Phone round the gp/midwives and explain the current medications aren't working, and ask for different options.

@romdowa

I was this way back in April, I was so unwell , none of the anti sickness medication worked for me either. The only thing I found that helped was eating little and often, making sure my stomach was never empty , taking rehydration sachets and a tablet for acid reflux. I gave myself whiplash from vomiting so much but from about 14 weeks it started to ease and I'm 27 weeks now and I only feel sick if I eat too much.

Thank you for the advice, the dehydration sachets and acid reflux tablets are a great idea, i will get some from the pharmacy when I pick her prescription up today.

She hasnt been eating much, and when she has been eating its been things like toast and cereal, basically stuff that she thinks wont be too bad coming back up in 5 minutes time... She doesnt have much of an appetite either, she will go from not being hungry at all to being absolutely starving and has to eat immediately within a few minutes!

The other thing is smells are really making her stomach turn, she can't open the bin or the fridge without needing to vomit! So she is very limited in what she can eat, anything with a strong smell is a no-go

I wouldn't have cereal because of the milk, I couldn't bear toast because it was hot and therefore I could 'smell it too much'.

Digestive biscuits were good for me!

@Cupidity

It's horrible, I had severe HG with both pregnancies requiring hospital admissions.

The best anti emetic was Ondansetron, but they don't like to prescribe it as its so much more costly than cyclizine/metaclopamide. My first pregnancy I just about survived taking both metaclopamide and cyclizine, my second I got Ondansetron which was a life changer.

Could you go to a pharmacy and get her some urine dip sticks? Whenever her ketones reach 3 or 4 she needs to go back into hospital to be put on a drip.

Keep an eye on her weight, I think I lost 15% of my body weight between week 6 to 12.

Phone round the gp/midwives and explain the current medications aren't working, and ask for different options.

Thank you! I will get her to speak to her GP about Ondansetron.

She has Keto sticks already, she took one this morning, but it was only a trace amount, but it was clear a couple days ago, so she is already heading back towards that again.

Yeah, she lost a lot of weight quite quickly (around 7lbs in the space of 10 days). After her hospital admission last week she was able to eat properly her weight has so far stayed there, but if she continues as she is at the minute, she will start losing more weight.

Thanks again!

I'm 17 weeks at the minute with HG, living on metaclopramide and prochloraperazine, I can just about keep crackers down and oddly Elderflower Presse, no water, water makes everything worse.
My advice is to be there for her, get her whatever she feels like drinking/eating, even if it comes back up.
Cyclizine is the first pill they try people on and they didn't work one little bit for me, ondansatron was great but as people have said they don't like to prescribe.

Can she drink anything? I couldn't stomach water, but warm flat Coke (full sugar) would occasionally stay down. I think its slightly trial and error to find foods that will stay down better than others.

Read the NICE guidelines and RCOG guidelines on nausea and vomiting in pregnancy, and then advocate for your wife, to the GP and midwife (think of it as practice for when she's in labour).

As others have said there is now that can be done, including ondansetron.

Also make sure the toilet is always spotlessly clean and tidy, and clean the fridge regularly when she is well out of the way to keep on top of odours.

I agree with trying to get Ondansetron- it was the only thing that worked for me. It had to be prescribed by a hospital consultant both pregnancies for me but then the gp was able to carry on prescribing it. Coke with sugar added until it went flat was recommended to me by a gp at one point and that helped get my blood sugar up and hydrated enough to eat some food. Breadsticks, hula hoops and plain jacket potato were the only things I could eat for most of both pregnancies, be willing to get whatever she thinks she might be able to eat from the shop. You will both get through this, your wife needs to you be strong and she'll get herself back when this passes but hyperemesis is an awful thing to go through and affected my husband too with trying to care for me and work full time.

Theres nothing you can do other than just be there for her emotionally and helping out with cleaning, housework etc. She, and you just has to ride the storm!

@MissMaple82

Theres nothing you can do other than just be there for her emotionally and helping out with cleaning, housework etc. She, and you just has to ride the storm!

That is ridiculous and unhelpful advice that is not in line with current best practice. There is plenty more that can be tried, and in no other area of medicine would someone with such severe symptoms be so quickly dismissed.

Until she's admitted to hospital again no there isn't anything you can do. She on meds already!

If it helps, another vote for Ondansetron. It almost completely halted the vomiting for me. (Still experienced nausea after but less.) GP wasn't much use but midwife referred me to the obstetrician who prescribed. Obstetricians advised at the time that GPs encourage sparing use of ondansetron but, as specialists, they wanted me to take the maximum dose. Locum GP also helpfully advised that ondansetron was expensive but now is a fraction of what it was and is not really an expensive drug, just outside expertise of most GPs It is used very commonly by women in my area and I was put under obstetrician's care for rest of pregnancy.
In terms of what else you can do, lots of sympathy and be nice. When she can and wants to eat, offer to bring her exactly what she thinks she can eat (even if it's chips or crisps and not what she normally likes.) You sound very nice! Good luck to both of you!

Thank you all for the great advice, it helps to know there is another form of medication she can be prescribed, now just the battle of actually getting it prescribed to her! I will speak to the GP surgery myself today and push for that.

Will pop out and get her some full fat coke, and plain food and snacks, along with the re-hydration sachets and acid reflux tablets. Fingers crossed she doesnt need to go on like this for much longer!

Thank you all again.

I’ve had hg and the only end that worked for me was either cyclizine or promethazine. Have a look on the pregnancy sickness support website for some good advice. Make sure your home is free off all smells, get rid of candles, reed diffusers, fruit bowls, even strong washing powder can make some women sick. Get her to try lemonade (not diet) it was one of the only things I couldn’t stomach. Good luck.

oh and goes without saying but support her in kicking up a fuss until she gets the treatment and management she needs. One midwife and my GP both advised me that there wasn't much they could do so I put up with it for far too long. Luckily spoke to different midwife and when I spoke again to original one, she said well I didn't realise how bad it was, I assumed you'd come back or speak to the GP if it was really that bad!

I used to be able to keep Lucozade down for a bit and it wasn't too unpleasant when it came back up - I hoped that some of it had stayed. I tried to eat something just before I went to sleep in the hope that I would sleep through the need to throw it up again.

Hello @keldog, I’m sorry to hear your wife is suggesting. I had 2 HG pregnancies to 18 weeks, and they were the most grim times of my life. I was in and out of hospital in both pregnancies.

At one point all I could do to stay hydrated was to melt ice cubes in my mouth.

There is a lot of useful medical, emotional, practical and legal support at Pregnancy Sickness Support.

If your wife works, please know that pregnancy related sick leave must be recorded separately, and can not be used in disciplinary action against her. Maternity Action (charity) can help with this if she has issues.

I had HG for both pregnancies and once my medication was kept down (a challenge in itself) I survived on ready salted crisps and orange ice lollies. Think that that was all I consumed between 10-20 weeks pregnant. The lollies were good because I was so dehydrated and I could just suck them. Could be worth a try.

Poor DH had to limit what he cooked for himself because I was so sensitive to smells. So you could try and eat things which aren't too smelly either.

Good luck to you both

She really should try ondansetron as others say. Think of it as being violently allergic to food. So you have to think of what’s not very much like food and test those - fake flavours- soft fruit jubes, sour lollies, potato crisps, soft drink. Also very quick and easy to eat with simple flavours so you can try and pretend you’re not eating - segmented mandarine/satsuma, tinned peaches, citrus sorbet (not mango, raspberry- too strong a flavour). And ice cubes with a few drops of orange or lemon juice and a pinch of salt and sugar for the worst times as you do absor liquid through your mouth. Very plain flavours like water crackers too.
On better days I ate a few tbsp of Cheerios or rice bubbles with milk - slips down again so your brain can almost not know you’re eating.
And always have a drink nearby, every sip adds up.it’s a shit time sorry!!

Quick update, I went to the GP surgery and explained to reception how severe it is today and she really needs some help from the GP. Got the usual "we are fully booked today, but will try and get the doctor to ring her at some point today" I passed her then name of ondansetron and stressed how important it was she spoke with the doctor before the weekend.

Anyway, by the time I had got home, the doctor had already called her.

Firstly, he said it was ridiculous that the midwives won't admit her to hospital until her ketone levels are high, and can't understand why they don't try to prevent that happening rather than just treating it when it does. He said if needed go to A&E as a workaround, as they will have to treat you if you do.

The other issue is he warned her against ondansetron in the first trimester as it has been known to cause cleft pallet. As his patient, he would happily prescribe her it if that is what she wanted, but advised against it and she isn't willing to take the risk (which I agree with). So she is not much further forward on that respect, but I did get her some dioralyte and lots of very plain easy to eat snacks, and some full fat coke.

Hi, I really sympathise as I has HG with my first. I spent the last 6 weeks of pregnancy in hospital. I found salty snacks good (ready Salted crisps is probably in my sons dna). Also ice lollys. Rehydration sachets are great.
I had the little tablets you put between your lip and your gums. They were okay but nothing to write home about. Ginger nut biscuits can be okay.
I'm sorry I can't be more help but I hope it calms down a little.

Ondansetron was the only thing that worked for me, food or even the thought of food ( tv programmes included) would make me heave.

rest was the only other thing - lying down doing as little as humanly possible.