|Year : 2012 | Volume
| Issue : 2 | Page : 61-64
Vomiting in early pregnancy as seen in a tertiary hospital in North-West Nigeria
Ibrahim Adamu Yakasai, Emmanuel Ajuluchukwu Ugwa, Diggol Ibrahim Garba
Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
|Date of Web Publication||12-Mar-2013|
Ibrahim Adamu Yakasai
Department Obstetrics and Gynaecology, Aminu Kano Teaching Kano, PMB 3452, Kano
Source of Support: None, Conflict of Interest: None
Background: Vomiting is a common complaint in early pregnancy. It is experienced in 80% of pregnancies and usually remits after 14 weeks. The aetiology is unknown, although there are various likely mechanisms, including the role of human chorionic gonadotrophin and its probable thytrophic activity. Objective: To review the presentation of patients coming with vomiting in early pregnancy and identifiable causes, at Aminu Kano Teaching Hospital (AKTH). Materials and Methods : Consecutive pregnant women's records, who presented with vomiting in early pregnancy between January 1 2010 and December 31 2011 in the gynecological emergency unit of AKTH, were retrieved. Information on clinical presentation, laboratory tests and pelvic ultrasound scans were extracted. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16 and P < 0.05 was considered significant. Results: One thousand eight hundred and fifty-six patients were seen. Sixty-one were due to vomiting in pregnancy, giving an incidence of 3.3%. Vomiting in pregnancy was the most common among those aged 21-30 years (48.3%), compared to those aged 31-40 years (16.7%). The differences was statistically significant ( P = 0.01). Most patients were in their first pregnancy or had only one previous delivery (50%). The condition was uncommon at higher parities. The differences were statistically significant ( P = 0.001). Majority of the patients presented at 6-15 weeks (96.6%) compared to 16-20 weeks (3.3%) gestation. The etiology of vomiting was unknown in 36.7% of the patients, was urinary tract infection (UTI) in 31.7%, malaria in 23.3%, gastroenteritis in 5% and peptic ulcer disease in 3.3%. Conclusion: The cause of vomiting in early pregnancy is unknown in a third of all cases studied. UTI is the commonest known cause of vomiting in pregnancy in our centre.
Keywords: North-West Nigeria, early-pregnancy, vomiting
|How to cite this article:|
Yakasai IA, Ugwa EA, Garba DI. Vomiting in early pregnancy as seen in a tertiary hospital in North-West Nigeria. Niger J Basic Clin Sci 2012;9:61-4
|How to cite this URL:|
Yakasai IA, Ugwa EA, Garba DI. Vomiting in early pregnancy as seen in a tertiary hospital in North-West Nigeria. Niger J Basic Clin Sci [serial online] 2012 [cited 2021 Jun 23];9:61-4. Available from: https://www.njbcs.net/text.asp?2012/9/2/61/108464
| Introduction|| |
Vomiting is a common complaint in early pregnancy, and 30-50% of pregnant women experience vomiting, with a higher percentage experiencing nausea.  Most cases are mild and resolve by the 20 th week of gestation.  Hyperemesis gravidarum is at the other end of the spectrum and is characterized by persistent nausea and vomiting that results in dehydration, ketosis, electrolyte imbalances and weight loss. 
The pathophysiology of vomiting and hyperemesis gravidarum in early pregnancy is poorly understood, but probably encompasses several factors. These include hormonal, biochemical, mechanical and psychological factors. In one comparative study, women with nausea and vomiting of pregnancy were found to have elevated levels of human chorionic gonadotropin (hCG).  However, this finding was not duplicated in another study.  Some studies have shown elevated estrogen levels in women with this condition, whereas others have not. , Therefore, the roles of hCG and estrogen remain controversial.  Many pregnant women with hyperemesis have suppressed thyrotropin-stimulating hormone (TSH) levels. Work is on-going to elucidate the interaction between hCG and TSH in pregnant women with hyperemesis. 
Vomiting in pregnancy begins between the fourth and 7 th week after the last menstrual period in 80% of pregnant women, and resolves by the 20 th week of gestation in all but 10% of these women.  Earlier studies showed that pregnancies complicated by vomiting had better outcome. , The condition has been shown to be more common in urban women than in rural women. , A recent study suggested that chronic infection with Helicobacter pylori may play a role in hyperemesis gravidarum. 
Vomiting in pregnancy was thought to be psychological. One study suggested that women with hyperemesis have hysteria, excessive dependence on their mothers and infantile personalities.  Gastrointestinal tract dysfunction has also been suggested as a cause of nausea and vomiting in pregnancy.
Medical conditions such as malaria, uremia and urinary tract infections (UTIs) , and surgical disorders such as peptic ulcer disease, and appendicitis are important causes of vomiting in pregnancy.  Twisted ovarian cyst and degenerating fibroids may also cause this distressing symptom. 
| Materials and Methods|| |
Consecutive pregnant women who presented with vomiting in early pregnancy (defined here as pregnancy of ≤20 weeks), at the gynecological emergency unit of Aminu Kano Teaching Hospital Kano, between 1 st January, 2010 and 31 st December, 2011 with vomiting in early pregnancy were the subject of this study. Information on clinical history, examination, malaria parasite test, urine m/c/s and pelvic ultrasound scan were extracted from the case records. It is a prospective study and these investigations are routinely performed for all patients admitted with these symptoms.
The relationship between the pregnancy symptoms of vomiting and various socio-demographic and obstetrics characteristics was determined using Pearson's Coefficient of Correlation. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 16, and P < 0.05 was considered significant.
| Results|| |
Between 1 January, 2010 and 31 December, 2011 a total of 1,856 women were seen during the study period. Of these, 61 were seen for vomiting in pregnancy. This gave an incidence of 3.3%. One case was dropped because of conflicting diagnoses. Accordingly, 60 women were analyzed in this study.
As shown in [Table 1], vomiting in pregnancy was the most common among those who were aged 21-30 years (48.3%), compared with those who were 16-20 years (35%) and 31-40 years (16.7%). The differences were statistically significant ( P = 0.01). The mean age was 25 years ± 5 years. Most of the patients were either in their first pregnancy or had a previous single delivery (50%) and the condition was uncommon at higher parities. The differences were statistically significant ( P = 0.001). The mean parity was 2 ± 2.
As shown in [Table 2], most of the patients presented at 6-10 weeks (48.3%) and 11-15 weeks (48.3%) than at 16-20 weeks (3.3%) of gestation. The mean gestational age at presentation was 10.5 weeks ± 3.5 weeks. Majority of the women presented early at onset of symptom, 1-2 days (36.7%), followed by 7-8 days (23.3%), and 5-6 days (16.7%). Those who presented 3-4 days or 9-10 days after onset of symptom were the least (11.7%). Mean duration of symptom at presentation was 4.9 days ± 2.9 days. Duration of hospitalization was short in most of the patients, 1-2 days (40%), followed by 7-8 (20%), 3-4 (16.7%), 5-6 (13.3%) and 9-10 (10%). Mean duration of hospital stay was 4.4 ± 2.8. The durations of symptom before presentation and length of hospital stay showed weak positive correlation (Coefficient of Correlation, r = 0.15). At the time of presentation, most of the patients had their first episode (86.7%), while the remainder (13.3%) had a recurrence.
|Table 2: Distribution of gestational age, duration of symptoms and hospital stay at presentation|
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As shown in [Table 3], the etiology of vomiting is unknown in a significant percentage of the study group (36.7%), followed by UTI (31.7%), malaria (23.3%), gastroenteritis (5%) and peptic ulcer disease (3.3% each).
| Discussion|| |
Vomiting is a common complaint encountered in early pregnancy. About 30-50% of pregnant women experience vomiting. , It is a very important cause of vitamin B ,, deficiencies.  The cause of vomiting in pregnancy is likely to be multifactorial, and the disorder is a diagnosis of exclusion. 
The incidence of vomiting in pregnancy, as shown in our study, was 3.3% because only early pregnancies (≤20 weeks) were considered. Previous reports showed an incidence of as high as 50% when all pregnant women were considered, irrespective of gestational age. ,
This study showed that vomiting in pregnancy was the most common in the age group 21-30 years and the mean age was 25 years ± 5 years. It was more common among those in their first or second pregnancies compared with those of higher parities. The mean parity was 2 ± 2. In a collaborative perinatal project,  factors associated with early pregnancy vomiting were investigated in 9098 first-trimester registrants; it was found that majority of the women had no identifiable cause of vomiting, compared to our findings, where in 37% of the patients no cause was found for their vomiting.
In most cases, vomiting in pregnancy is self-limiting and tends to resolve around 20 weeks' gestation. , The report of this study showed that most of the patients presented at 6-10 weeks (48%) and 11-15 weeks (48%) than at 16-20 weeks (4%) of gestation. This compares favourably with the findings of Loh and Sivalingam, who reported that in majority of women vomiting begins between 6 weeks and 9 weeks of pregnancy. , Samba and Kwawukume also reported that symptoms start commonly after the first missed period.  Vomiting in pregnancy in the present study was more common among women of younger age and lower parity, especially those of parity 0-1. This is in agreement with previous studies. ,
Majority of the women in our center presented early at onset of symptom (1-2 days). Mean duration of symptom at presentation was 4.9 days ± 2.9 days. Duration of hospitalization was also short (1-2 days) in most of the cases (40%). The mean duration of hospital stay was 4.4 ± 2.8. This is similar to findings that 35% of the women studied spent a mean of 62 h away from their paid work because of symptoms of nausea and vomiting, showing the socioeconomic significance of this condition.  The durations of symptom before presentation and length of hospital stay in the present study showed a weak positive correlation (coefficient of correlation, r = 0.15). These are shown in [Table 2].
This study showed that the etiology of vomiting in pregnancy was unknown in a significant percentage of the study group (36.7%). Known causes were UTI (31.7%), malaria (23.3%), gastroenteritis (5%) and peptic ulcer disease (3.3%). Although documented evidence of the importance of the above etiological factors exist, , researches that showed their relative frequencies are few.
Although this review was not on the drug treatment for emesis gravidarum, in the 36.7% women who had no identifiable cause for their vomiting, the antihistamine promethazine was given to them that promptly relieved their symptoms of vomiting. All drugs should be avoided during the first trimester; however, if an antiemetic is required the antihistamine promethazine appears to be safe and effective. This guided our choice of this drug among our patients. 
Screening to determine the causes of vomiting in pregnancy should include clean catch urine specimen for microscopy, culture and sensitivity as well as examination of blood film for malaria parasite. By so doing, UTI, which may lead to early miscarriage and the serious consequences of malaria in pregnancy (compromises fetal growth and low-birth weight), can be avoided. 
| Conclusion|| |
Our study showed the cause of vomiting in early pregnancy is unknown in a third of the cases, and that UTI in pregnancy presented with vomiting more commonly compared with malaria.
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[Table 1], [Table 2], [Table 3]