Hyperemesis Gravidarum

Question 1

What is hyperemesis gravidarum?

Answer 1

Nausea and vomiting in early pregnancy, so severe as to cause severe dehydration, weight loss or electrolyte imbalance. Rarely persists beyond 14 weeks.

Question 2

What is this a presentation of?
Pregnancy woman, inability to keep food or fluids down, decrease in weight, dehydration, hypovolaemia, tachycardia, postural hypotension, hyponatraemia, hypokalaemia.

Answer 2

Hyperemesis gravidarum

Question 3

How is hyperemesis gravidarum investigated?

Answer 3

1. Exclude UTI and ketones (severe dehydration) with urine dip
2. Exclude molar pregnancy (USS)
3. Check electrolytes - admit if unable to keep anything down despite oral antiemetics

Question 4

What is the management for hyperemesis gravidarum?

Answer 4

1. IV hydration
2. Antiemetics - metoclopramide, cyclizine
3. Thiamine
4. Psychological support
5. If intractable, consider PO prednisolone/IV hydrocortisone