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What causes constant vomiting in a 28 week pregnant woman?

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Posted on Fri, 24 Jun 2016
Question: Hi!
My sister is 28 weeks pregnant, had been vomiting nonstop for 2 days prior to been admitted to the hospital. At the hospital, nobody was able to determine what was causing the vomiting since there were no other symptoms. We thought it could be a lap band she had installed in 2004 therefore, we called the md who performed the initial procedure and it led to 2 surgeries under general anesthesia so that her lap band could be removed (reasons why the md did not removed it on the first trial as he said he would are unknown). During the second attempt the md, punctured the uterus, and we are really concern about how that will affect the growth of the baby and or chances of infection.
It s already been six days after the second surgery and she is still vomiting nonstop, this time was admitted at a high risk obstetrics hospital with a level 3 NICU. MD s still do not know whats causing the non stop vomiting, and now because she has been under IV but dehydrated, she's had several contractions. mri showed two cysts one on top of the liver and the other on the kidney. What should we do at this point? we are extremely concern for both my sister and her baby's health now and in the future. can all the meds she has taken cause malformations for the baby? cerebral palsy? or neurological problems? should we request for her to have a c-section? if so, is that a better option for the baby?
Any advice will be appreciated!
doctor
Answered by Dr. Nishikant Shrotri (33 minutes later)
Brief Answer:
Surgeon's opinion will be valuable

Detailed Answer:
Dear XXXX,

The history of your sister you have narrated has raised few questions in my mind:

1. If she has had Lap band (around her tubes) how did she conceive?
2. When was the lap bad removed - after the vomiting started or before?
3. Otherwise what was the indication of removal of the band?

Will you please clearly answer these questions without using any short forms to make the history more explanatory?

If during the band removal, there was injury to the uterus and the vomiting has started after that, the possibility of blood leaking from the uterus should be considered and evaluated further. However, MRI she has undergone does not reveal any evidence of blood in the peritoneal cavity nor any evidence of any infection nor injury to the intestines. In fact, I would have suspected one of these three with the history provided.

Caesarean delivery at 28 weeks pregnancy will not be helpful for the babies health and survival. The baby is too small and too premature to survive outside the mother's womb - though mot impossible.

The cysts on the liver and kidney need to be investigated more. They could be the cause of vomiting; however, their sizes suggest that they are not so fresh and should be quite old ones.

Before I opine on the ill effects of the medicines on the baby, would you please specify the names and contents with their dosages of medicines? I would appreciate if you upload all the available reports?

I feel, you should have an expert opinion of a surgeon on this issue. It seems to be a surgical complication.

Please revert back with the information I have asked. For any more information, I am always available for you, XXXX.

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Follow up: Dr. Nishikant Shrotri (1 hour later)
Thank you for your prompt response!

The Lap band/ bariatric procedure was placed above the stomach, and because it had been placed around the esophagus for so many years the doctor said he could not remove it the first surgery due to too much scar tissue. since her vomiting did not ceased, and the doctor did not want to give the baby radiation he decided to bring an Gastro doctor and do a endoscopy while he removed the lap band on the outside of the esophagus. (2 days later) se felt a little bit better but 6 days later she continues to vomit non stop and has not been able to even lick ice because she vomits green foam. the puncture on the uterus was caused when the bariatric doctor performed a laparoscopic procedure. ( i guess to maneuver the removal of the band ) yet I don't know why he did 6 incisions throughout the abdomen??? when transfer her to a critical unit hospital and the new bariatric doctor said that the original doctors notes are really vague/poor documentation. as far as the drug reports, notes i will have to request them therefore, i will enclosed them once provided. Thank you!
doctor
Answered by Dr. Nishikant Shrotri (12 hours later)
Brief Answer:
I maintain to get Surgeon's oinion; X-ray abdomen in standing position

Detailed Answer:
Dear XXXX,

I hope I am spelling your name correctly, if not, please correct me.

Considering more details of your sister's history, I have following differential diagnosis of her continuous vomiting:

1. Since the lap band was applied at the lower end of the oesophagus or may be cardiac sphincter of the stomach, it seems her cardiac sphincter was week probably resulting in the regurgitations. Now that the band is removed, the sphincter is unsupported and hence the repeated regurgitations. However, in upright positions, stomach contents should not regurgitate. The very fact she is throwing immediately after ingestion of even liquid, something inside is not allowing the material to pass forward. Moreover, the vomiting of green foam suggest that there is obstruction distal to the duodenum. This could be mechanical obstruction or may be functional obstruction due to some infection and/or irritation of peritoneum due to blood in the peritoneal cavity. With the history of uterine puncture during removal of the band, the later possibility seems to be more probable. The pregnant uterus may continue to leak.

Please have her X-ray of abdomen in the standing position. If more than 3 fluid levels are seen in the X-ray, it is confirmatory of intestinal obstruction. However, subacute obstruction may not have a typical classic picture.

Does your sister pass flatus and/or bowel motions regularly? Constipation and/or obstipation are common symptoms of the obstruction. Again I maintain my opinion that she needs to have Surgeons opinion.

If it is a mechanical intestinal obstruction, she may need opening the abdomen. Functional obstruction (Paralytic ileus) may be treated either conservatively or may require opening of abdomen depending upon the causative factor and the pathological damage.

2. There could be local gastro-enteric irritation causing regurgitations which due to week cardiac sphincter is getting vomited out. However, to me this probability seems rather remote.

3. Considering the history of green vomitus, I would advise to get her liver function tests performed. Liver dysfunction can cause continuous vomiting with nausea and anorexia and such vomitus is green in colour. Does she have any jaundice? What is the colour of her stools and urine? Also please get her serum bilirubin tested.

Since she has crossed 14 weeks, the medicines Magnesium, prortonix, potassium chloride should not cause any harm to the baby in the uterus.

I would be keen to know the results of the advised investigations and opinion of a Surgeon.

Please feel free to ask for any more information without hesitation.

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Nishikant Shrotri (10 hours later)
Hello Dr. Shrotri,

Thank you for your opinion! I will request for the treating physician to prescribe the tests you mentioned.

I really appreciate your help!
Thanks!
Yessyka
doctor
Answered by Dr. Nishikant Shrotri (1 hour later)
Brief Answer:
Awaiting for the further development.

Detailed Answer:
Dear Yessyka ,

I am indeed happy that I could be of some guidance to you. I am awaiting for the further development and the reports. Please keep me informed.

Meanwhile, since you have found this discussion helpful, how about posting a good review with 5 star rating for me?

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Nishikant Shrotri

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What causes constant vomiting in a 28 week pregnant woman?

Brief Answer: Surgeon's opinion will be valuable Detailed Answer: Dear XXXX, The history of your sister you have narrated has raised few questions in my mind: 1. If she has had Lap band (around her tubes) how did she conceive? 2. When was the lap bad removed - after the vomiting started or before? 3. Otherwise what was the indication of removal of the band? Will you please clearly answer these questions without using any short forms to make the history more explanatory? If during the band removal, there was injury to the uterus and the vomiting has started after that, the possibility of blood leaking from the uterus should be considered and evaluated further. However, MRI she has undergone does not reveal any evidence of blood in the peritoneal cavity nor any evidence of any infection nor injury to the intestines. In fact, I would have suspected one of these three with the history provided. Caesarean delivery at 28 weeks pregnancy will not be helpful for the babies health and survival. The baby is too small and too premature to survive outside the mother's womb - though mot impossible. The cysts on the liver and kidney need to be investigated more. They could be the cause of vomiting; however, their sizes suggest that they are not so fresh and should be quite old ones. Before I opine on the ill effects of the medicines on the baby, would you please specify the names and contents with their dosages of medicines? I would appreciate if you upload all the available reports? I feel, you should have an expert opinion of a surgeon on this issue. It seems to be a surgical complication. Please revert back with the information I have asked. For any more information, I am always available for you, XXXX. Dr. Nishikant Shrotri