Hyperemesis

Question 1

What

Answer 1

The RCOG guideline (2016) criteria for diagnosing hyperemesis gravidarum are “protracted” NVP plus:

More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance

Question 2

Severity

Answer 2

Assessing the Severity
The severity can be assessed using the Pregnancy-Unique Quantification of Emesis (PUQE) score. This gives a score out of 15:

< 7: Mild
7 – 12: Moderate
> 12: Severe

Question 3

Treatment

Answer 3

Management
Antiemetics are used to suppress nausea. Vaguely in order of preference and known safety, the choices are:

Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide

Ranitidine or omeprazole can be used if acid reflux is a problem.

The RCOG also suggest complementary therapies that may be considered by the woman:

Ginger
Acupressure on the wrist at the PC6 point (inner wrist) may improve symptoms

Mild cases can be managed with oral antiemetics at home. Admission should be considered when:

Unable to tolerate oral antiemetics or keep down any fluids
More than 5 % weight loss compared with pre-pregnancy
Ketones are present in the urine on a urine dipstick (2 + ketones on the urine dipstick is significant)
Other medical conditions need treating that required admission

Moderate-severe cases may require ambulatory care (e.g. early pregnancy assessment unit) or admission for:

IV or IM antiemetics
IV fluids (normal saline with added potassium chloride)
Daily monitoring of U&Es while having IV therapy
Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission