Hyperemesis Gravidarum

Original Editor - Rishika Babburu

Top Contributors - Rishika Babburu, Kim Jackson and Vidya Acharya  

Introduction

Nausea and occasional vomiting are common in early pregnancy (NVP) . It affects 50%-80% of pregnant women during the first half of gestation. When vomiting is severe or protracted, it is often referred to as hyperemesis gravidarum (HG). It is generally referred to as “morning sickness,” for many women symptoms persist over the whole day.HG may effect 0.3–2% of pregnancies and it is defined by dehydration, ketonuria, and more than 5% body weight loss.

Aetiology

Genetics

History of asthma/other respiratory tract infections

Intake of saturated fat, no intake of ginger, inadequate intake of vitamin B

Clinical signs

• Symptoms may include a broad spectrum of severity ranging from occasional nausea to intractable vomiting.
• Nausea and vomiting begins in the first trimester around six to nine weeks’ gestation and settle by about 12 weeks.
• Few women have symptoms after 20 weeks of gestation.

Differential diagnosis

• Gastrointestinal disorders
• Gastrooesophageal reflux disease
• Pancreatitis
• Pepticulcer disease
• Bowel Obstruction
• Endocrine and metabolic disorders
• Ovarian torsion
• Migraines
• Vestibular Disease
• Eating disprders such as anorexia nervosa ,bulimia
• Genitourinary and renal disorders are to name a few conditions in differential diagnosis.

Treatment

Women who suffer from HG are often counselled on self limited course of symptoms and are advised to avoid foods, odours and activities that may trigger nausea or vomiting.Hospital admission is indicated when there is significant weight loss, electrolyte abnoramlities or persistant vomitings after rehydration .Symptoms may improve in a day or two following inpatient treatment.Antihistamines (H1 antagonists), including doxylamine is used in combination with pyridoxine, meclizine, dimenhydrinate, and diphenhydramine.They are to be administered strictly under medical supervision.