HG treatment in the UK

Welcome to a special place for mothers who live in the UK to discuss HG and pregnancy. Each part of the world has unique health care systems and challenges. We hope this helps you connect with others who can be the best support for you! Don't forget - we always welcome your participation in our online research and your help as a volunteer or by submitting a HG-friendly doctor/consultant.

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HG treatment in the UK

Postby Natalie » Mar 22, 2007 7:25 pm

Hello UK ladies!

This sticky on HG treatment in the UK is in different parts. It includes tips on how to prepare for an HG pregnancy and some ways in which you can reasonably expect an HG pregnancy to be managed in the UK.

If you have anything to add, please do let either Natalie or Sarahkate know and we will do our best to incorporate your feedback.

Preparing for trying to conceive (ttc).

Please start by reading this very important link:
http://www.helpher.org/mothers/get-goin ... gain.php#1

Follow usual preconception guidelines:
This webpage has all the basics http://www.bbc.co.uk/parenting/having_a ... ndex.shtml

Join in the HER forums:
If you are a lurker, please sign up and join the HER forums. The 'New to Forum...' forum is a good place to start, plus this forum (HG outside the US) and the Preparation for HG forum. The feedback on your preparation can be invaluable. And then of course TTC forum when the time has come.

Write yourself a protocol:
Take a look at this sticky at the top of he Preparation for HG folder... http://forums.helpher.org/viewtopic.php?t=6140. I cut and pasted all of these protocols into one enormous Word document and then edited it to suit my situation e.g. childcare, when people will be around to support, what meds to try etc...

Line yourself up with an advocate:
Maybe your husband/partner/close friend? Make sure they are not going to abandon you when the going gets rough (prepare for the worst, expect the worst and if it isn't so bad as you had prepped for it can only be a good thing, right?) Print off information from this site about what HG is, how it can be managed best etc... make sure they are knowledgeable about the condition because you are going to need them to advocate for you if you find yourself so unwell that you no longer have the will to speak up for yourself any more.

Pre-ttc appointment with your GP:
It is worth your while making an appointment to see your GP to discuss a plan of action for your next pregnancy. If you can, take your advocate with you to the appointment. If you feel that your care was not as good as it could have been from your GP last time around, or that s/he doesn't seem to know that much about HG, either change to a different GP in the same practice or change GP practices altogether. I looked through the surgery pamphlet and identified which GPs had a special interest in babies / new mums (i.e. the ones who do the 6w check post partum) because I figured they would at least have heard of HG. Look for who has DRCOG. It will be on the basic list of Drs at a surgery. They will all be MB ChB (medical degree); most will have MRCGP (GP exams) but GPs who have dones Obs. + Gynae. often take the diploma in it which is very clinically based and means they have something of an interest

If the Dr. says that you may not get HG again, that is true. You may not but research shows that those with a prior Obstetric history of Hyperemesis are more likely to get it again in their next pregnancy see http://www.medscape.com/viewarticle/519867, that it begins earlier and that is often more severe that the previous pregnancy. You need to work out a management strategy that is going to keep you on top of the HG. Discuss what medicines you tried before, what worked, what didn't and what doses you were on. Work out how long you will give each medicine to see if it is working before you switch to a new one. For information on US-UK drug translations see http://www.hyperemesis.org.uk/ and click on the Drug information link.

Proactive treatment can help stave off the worst:
See http://forums.helpher.org/viewtopic.php?t=849. Recent research published by Motherisk in Canada shows that starting treatment before even the nausea starts is best see http://www.motherisk.org/prof/updatesDe ... ent_id=849. Remember that depression can be a factor when you are struggling with HG so don’t forget to add an anti-depressant into your protocol if you feel it might be necessary.

Request a referral to an Obstetrician:
At the GP appointment, request a referral to an Obstetrician before you get pregnant. If possible, try and go for your nearest largest teaching hospital, especially if you had a particularly severe HG pregnancy or you suffer with other pregnancy complications in addition to HG.

The GP or Obstetrician will probably try you on a number of medicines. The most common ones are listed here using their Generic Names followed by the most commonly used Brand Names in brackets: promethazine hydrochloride/teoclate (Phenergan), prochlorperazine (Stemetil), metoclopramide hydrochloride (Maxolon). It is true that Stemetil no longer comes in suppository form. There is an Orally Dissolvable Tablet (ODT) called Buccastem that you can try (if you can stomach the taste) and also an injection that GPs can administer.

Request a sick note:
The GP will hopefully have written one before you need to ask for it but unless it’s absolutely necessary for you to work, then imho, don’t! It is totally reasonable to request time off work when you are as sick as HG makes you. Also, don’t forget that stress and exertion can make HG worse so rest is a key factor in making it through.

Request a test for Helicobacter Pylori:
It is a bacteria that lives in the stomach and although it doesn't cause HG, it can exacerbate it. It's best to get a test and then if the test comes back positive you can take medicine to treat it.

Request an ultrasound scan:
In the (likely) event that you will get HG again, you could also try requesting an u/s (imho, after you have reached 6 weeks gestation) to rule out Molar or twin pregnancy. Having hopefully seen the baby’s heartbeat, it may help you connect with him/her when you are in the throes of HG hell, especially if you have a wee picture to look at.

Buy some Ketone testing strips:
You can purchase them from chemists or form the web. Type in ‘Ketone test strips’ into a search engine and a whole range of sites that sell them come up.

Get educated about HG:
Get your advocate educated about HG too so they can fight for you if necessary. Devour the information on website, it is an invaluable resource so use it. Print off the pertinent information and take it to your Doctor’s appointment if necessary.

Once you get your positive pregnancy test:
Again, if you are a lurker on the site then sign up! Introduce yourself in the first tri. folder and here in HG outside the US. I'm sure if you asked anyone who has endured an HG pgy, having the support (which you can never have enough of imo) and knowledge of the ladies on the site is inavluable. If you are having a really rough time of it, they will be the first to be there empathising and coming up with tips on how to keep battling. Even if you are too sick to sit at the computer, if you have a laptop you could use it in bed. Or if that is not possible (which it is for many in the first tri.) then dictate messages for your advocate to type up on the forum for you and then get him/her to print off your responses and read them to you.

Similarly, if you would like more local support, contact Pamelarose (Moderator of the First Tri. forum) who can line you up with a UK buddy who should be in your rough geographical location. You can discuss with them what level of support you would find helpful e.g. weekly email or phone call. Whatever you and they can manage.

If you are already pregnant and have or think you might have Hyperemesis.

Places to seek help:
1. Your GP - if you are keeping some food or fluids down and do not feel you are dangerously dehydrated it is worth seeing your GP. They can prescribe first line medications and sign you off work.
2. Early Pregnancy Unit. The larger hospitals in the UK have Early Pregnancy Units (with various confusing acronyms, EPU, EPAU, EGU) to which you can self refer. These primarily exist for miscarriage but will usually accept Hyperemesis. It may be worth finding out if they exist from your GP, from NHS Direct, or ring the A+E department at the hospital. They may often admit you to a gynaecology ward from here.
3. A+E. If your hospital has no EPU go to A+E.

What to expect on arrival at hospital:
They will ask you for a urine specimen to check for ketones. They may be surprised that you think this is a bit of a joke! They will take bloods, usually including a renal profile to check dehydration, thyroid profile to check for thyroid problems which may cause or worsen Hyperemesis, and usually liver function. They will usually weigh you. If you are ketotic or have abnormal bloods, expect to be admitted. They will start IV fluids. Not usually very fast, so it may take a long time for you to feel much better. You will get one or two antiemetics either rectally or as an injection. Common drugs are prochlorperazine, cyclizine, metoclopramide.

When you go home:
Make sure you get some of whatever antiemetics you have had to take home with you and ask what you are to do if they don't work/ when you are to come back in. If you've never been in hospital before, the doctors come round in the mornings and are notoriously difficult to get hold of the rest of the day so try and get all your questions in at that bright and early visit.

Antenatal booking appointment:
This is at 12 weeks and is usually with a midwife. You may have to push at this time to see a doctor - but if your hyperemesis is ongoing then do push for that. Ask what options there are for the ongoing management of your hyperemesis. What additional management you may need. Highlight your weight loss. They should have from your notes how many admissions you have had by this point.

Growth scans:
Some obstetricians will do these if your weight loss has been severe.

Ondansetron (zofran):
Expect to have to try other drugs first. Expect your hyperemesis to really have to 'prove itself' to get it. By all means ask for it. It is usually prescribed only by a consultant in the UK.

Sometimes used before ondansetron, sometimes after. You may be referred to a gastroenterologist if this is being considered.

(Anecdotal evidence suggests) Termination for HG is on the increase in the UK. Unfortunately it seems this is what it takes to get an improvement in care. If you are told that your hyperemesis is so bad that you are advised to terminate, ask for a second opinion. If you are feeling so desperate that the only way out seems to be termination, get someone to get you a second opinion as to whether you could be managed better.
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Postby debbie » Mar 29, 2007 11:33 am

Thanks Natalie.
Fantastic advice for us in UK
Erin Anne, 12.10.2000 HG
Rhys Hywel , 04.10.2002 HG
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