Sudden Nausea During Third Trimester
Sudden Nausea During Third Trimester: It can be hard to remember what day of the month it is when you are pregnant, but if you’ve been experiencing nausea since that first morning sickness bout, then you know how easy it is to lose track. Or maybe you missed a period, so you take an at-home pregnancy test only to discover you are not yet with child. The results aren’t back from the lab for days. By now, you are probably wondering whether this means anything serious has happened.
The truth is, most women who experience mild nausea throughout their entire pregnancies will recover without any problems. However, some women do experience more severe forms of nausea that require medical attention.
Although no one knows exactly why we get nausea (some experts say it’s due to hormonal changes, others blame dehydration), those who suffer through moderate to severe nausea typically don’t feel well enough to eat much beyond liquids and crackers. They often find themselves irritable and cranky because they simply cannot keep up with the demands of caring for a new baby.
Severe cases of nausea can cause complications that could affect both mother and fetus. For example, many doctors consider vomiting to be a sign of poor fetal health. If the stomach contents are being regurgitated into the mouth instead of going directly out through the birth canal, the risk of premature delivery increases significantly. This is called gastric aspirates and occurs when the infant swallows amniotic fluid while still inside the womb. In babies whose mothers experienced severe nausea, 30 percent were born prematurely.
Other risks associated with severe nausea include low blood sugar, which can lead to seizures; jaundice, which causes yellowing of the skin and eyes; and dehydration, as previously mentioned. To prevent these potential complications, seek help from a doctor immediately.
Now let’s look at other types of nausea commonly seen among pregnant women.
Reflux disease affects nearly everyone, although it becomes increasingly common as people age. Reflux happens when food travels upward rather than downward through the digestive tract, forming a “backward flow.” When this takes place in the esophagus, it leads to pain known as acid reflux. It can occur anywhere along the length of the digestive tract, but it usually starts in the lower part of the stomach near the pylorus valve. The pylorus valve regulates the passage between the duodenum and the small intestine. As the stomach empties into the small intestine, pressure builds up on the uppermost portion of the stomach where the pylorus valve is located. This causes the valve to close, preventing the stomach content from moving forward. Acid reflux occurs when the pylorus valve malfunctions and allows stomach acids to move backward into the esophagus.
Acid reflux isn’t harmful unless the amount of acid is large enough to damage the lining of the esophagus. Most people swallow too much liquid when eating, which puts additional stress on the gastroesophageal junction. Over time, repeated episodes of reflux can scar this area, making it less tolerant of normal amounts of stomach acid.
Nausea and reflux are closely related. One study found that 40 percent of patients diagnosed with postpartum depression had concurrent reflux disease. Therefore, treatment for reflux should be considered by anyone suffering from persistent nausea. Treatment options range from lifestyle modifications such as avoiding caffeine, alcohol and smoking to medications including antacids, H2 blockers, proton pump inhibitors and histamine antagonists. Lifestyle changes alone are not always effective, however. Medications work best when used together.
There are several different kinds of nausea. Many women notice it early on and seem to grow accustomed to it. But other women experience extreme nausea that makes even simple tasks difficult. Knowing what type of nausea you are dealing with can help you determine the proper course of action. We’ll discuss each kind next.
Pregnancy Nausea Symptoms
Although all women deal with nausea during pregnancy, not all nausea is created equal. There are three main categories of nausea: morning sickness, delayed nausea and non-morning-sickness nausea.
Most women start to feel queasy during the second trimester, although nausea can actually begin earlier. Morning sickness tends to peak about two weeks after conception. Some women never feel sick at all, while others feel extremely ill throughout the duration. Women tend to describe their nausea using words such as queasiness, gassy, bloated, full, sick to my stomach, retching, dry heaving, vomit, etc., depending on the severity.
Some women experience delayed nausea, meaning they become nauseous months later rather than minutes after consuming something. Delayed nausea is thought to be caused by multiple factors, including hormones, genetics, environmental toxins, nutritional deficiencies and allergies.
Non-Morning Sickness Nausea
This category includes nausea that doesn’t fit into either of the previous categories. Non-morning sickness nausea is generally milder than morning sickness nausea and tends to last longer. Causes of non-morning sickness nausea include infection (such as bacterial infections, parasites and viral infections); motion sickness; side effects of medication; psychological issues such as anxiety or depression; certain foods; spicy or salty foods; gastrointestinal disorders such as celiac disease, lactose intolerance, IBS and inflammatory bowel syndrome; gall bladder problems; polycystic ovarian syndrome; menopause; and hormone fluctuations.
Symptoms of Pregnancy Nausea
Women vary widely in terms of their response to nausea, so pay very close attention to your own particular reactions. Commonly reported symptoms include:
- Dry heaves
Treatment Options for Sudden Nausea During Third Trimester
What if you suddenly develop nausea? First, try resting quietly with your head elevated above the level of your chest. Taking deep breaths may help relieve feelings of discomfort. Avoid lying down until you receive clearance from your physician or midwife.
You should call your obstetrician right away to schedule an appointment. Your doctor will want to perform tests to rule out any underlying conditions that could be causing the symptoms. These tests could include a complete physical exam, blood tests, urine tests, x-rays, ultrasound and/or CT scan. Tests may also be performed to detect any sexually transmitted diseases.
Your doctor will likely prescribe anti-nausea medication, such as meclizine dihydrochloride hydrate, promethazine hydrochloride, chlorpromazine maleate, droperidol, domperidone, metoclopramide methylene disalicylate, diazepam and/or nordiazepam. Metoclopramide and droperidol, which belong to a group of drugs known as phenothiazines, reduce emesis by slowing activity in the chemoreceptor trigger zone in the brain.
Phenothiazines act as antagonists, blocking receptors that neurons use to send messages to the central nervous system. Meclizine works by inhibiting voltage-sensitive calcium channels in nerve cells. Diazepam produces its effect by acting on specific sites within the brain. Nordiazepam acts upon gamma amino butyrate (GABA) receptors. GABA is a neurotransmitter that helps control the transmission of information between nerves. Drugs such as domperidone and chlordiazepoxide block dopamine receptors. C
hlorpromazine reduces levels of prolactin, a hormone that stimulates milk production. Prolactin is believed to play a role in triggering nausea and vomiting.
In addition to drug therapy, there are various herbal remedies available over-the-counter that claim to treat nausea. Ginger root contains gingerols and shogaols, compounds that are said to relieve nausea. Cayenne pepper contains capsaicin, which has been shown to alleviate nausea. Other herbs that contain active ingredients that aid in treating nausea include feverfew, lemon balm, holy basil, fennel seed, licorice root and yarrow.
Unfortunately, there is no cure for nausea, nor is there any way to predict how you will react to pregnancy. The good news is that once you begin taking prenatal vitamins, the symptoms should subside.
For more information on nausea, see the stories on the following page.
Many women assume that morning sickness stops around the 20th week of pregnancy when the embryo implants into the wall of the uterus. Actually, some women report nausea past this point. A possible explanation is that the placenta hasn’t developed fully yet, leaving room for further growth and development.
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