Affects approximately 75% of pregnant women.
Typically begins between the fourth and seventh week after the last menstrual period and resolves in the second trimester.
Etiology remains unclear. There is some evidence that it is related to hormone levels of human chorionic gonadotropin and estrogen.
Hyperemesis gravidarum represents the most severe form of nausea and vomiting of pregnancy. While there is lack of consensus of definition, most agree that clinical features include persistent vomiting, volume depletion, ketosis, electrolyte disturbances, and weight loss.
Initial therapy should be conservative. This may include nonpharmacologic treatments such as diet modification, emotional support, ginger, and acupressure.
Severe cases may require hospitalization, intravenous fluids, antiemetics, corticosteroids, and total parenteral nutrition.
- first trimester of pregnancy
- weight loss of >5%
- absence of thyroid enlargement/nodules
- absence of CNS signs
- dry mucous membranes
- postural dizziness
- ketotic breath
1st Tests To Order
- basic metabolic panel
- serum LFTs
- serum BUN and creatinine
- serum TSH and free T4
- urine or serum ketones
- fetal ultrasound with nuchal translucency
- serum analytes
- Helicobacter pylori breath test
Other Tests to Consider
- urine culture
- serum amylase and lipase
- RUQ ultrasound
- renal ultrasound
- cranial CT or MRI
without volume depletion
- conservative management
without volume depletion but failed conservative management
- pyridoxine and/or doxylamine
- oral antihistamines or antiemetics
with volume depletion
- intravenous hydration
- parenteral or rectal antiemetics
- proton-pump inhibitor alone or in combination with antiemetic
- hyperemesis gravidarum: failed other therapies
- nutritional supplementation
- Helicobacter pylori-positive
- Helicobacter pylori eradication therapy