Background and Purpose
‘Imsin-Ojo’ [Nausea and vomiting of Pregnancy(NVP), 妊娠惡阻] is a condition characterized by nausea and vomiting as the main symptoms during pregnancy. This term comprises a range of conditions, including mild symptoms like Morning Sickness, Excessive Vomiting in Pregnancy(O21), Mild Hyperemesis Gravidarum(O21.0), and Hyperemesis Gravidarum with Metabolic Disturbance(O21.1). In Western medicine, the term ‘Imsin-Ojo’ may refer to excessive vomiting in pregnancy, which can be translated as ‘Hyperemesis Gravidarum’. There is a conceptual difference from the terminology used in traditional Korean Medicine. In the case of nausea, it occurs in 70-85% of pregnant women, and around 50% of cases involve vomiting. Among them, the frequency of symptoms being severe enough to be diagnosed as ‘Hyperemesis Gravidarum’ has been reported to be 0.3-10.8% for pregnant women. One study reported that, among outpatients who visited the Department of Korean Medicine Obstetrics and Gynecology, the proportion of pregnant women was 4.3%, and among them, those with hyperemesis gravidarum formed the highest proportion, accounting for 37% of pregnant women. Furthermore, among pregnant women who received herbal medicine during pregnancy, the incidence of hyperemesis gravidarum was the highest, ranging from 28% to 61.8%. In addition, Korean Medicine treatment based on acupuncture is recommended by major medical guidelines in foreign countries, prompting the need to develop clinical treatment guidelines with standard recommendations for the Korean Medicine treatment of Nausea and vomiting of Pregnancy.
Overview of disease
Symptoms of nausea, dizziness, and vomiting during pregnancy, including vomiting as soon as food is swallowed in severe cases, are known as ‘Imsin-Ojo’ [Nausea and vomiting of Pregnancy(NVP; ‘妊娠惡阻’or ‘妊娠阻病’)]. In Korean Medicine, NVP includes not only mild morning sickness or mild nausea of pregnancy, but also severe symptoms of hyperemesis gravidarum (HG) during pregnancy. In the medical data, ‘Excessive Vomiting in Pregnancy’ is sometimes referred to as ‘Hyperemesis Gravidarum’. If vomiting becomes more severe and accompanies metabolic disorders, it is known as ‘hyperemesis gravidarum with metabolic disturbance’ or ‘hyperemesis gravidarum with metabolic dysfunction’.
Nausea and vomiting are common symptoms up to the 16th week of pregnancy. However, if vomiting is frequent and severe, early treatment is essential. Immediate vomiting upon swallowing food not only significantly weakens pregnant women but also impacts the development of the fetus.
If not accompanied by weight loss or dehydration, it is considered physiological range of morning sickness or mild NVP. However, if there is weight loss,
dehydration, starvation or an electrolyte imbalance such as hypokalemia due to severe vomiting, it is considered moderate or severe NVP, so appropriate treatment is required. If vomiting persists, acute renal failure may occur, and severe side effects such as esophageal rupture or pneumothorax may occur. In addition, if properoral nutrition is not possible, intravenous fluids, nutrition supply, and tube feeding should be initiated.
Within the recommendations outlined in this clinical practice guideline, the recommendations to apply Korean Medicine treatment alone consider clinical situations in which oral food intake is voluntary. The recommendations to combine Korean Medicine treatment with conventional medical treatment consider clinical situations in which food intake is voluntary but the symptoms are severe or food intake is difficult due to severe NVP or symptoms of HG.
