Hyperemesis gravidarum--assessment and management

Nausea and vomiting are common symptoms in early pregnancy. In most women the condition is mild and self limiting. A small percentage of women experience severe nausea and vomiting. This is known as hyperemesis gravidarum. Outcomes have improved with intravenous rehydration therapy. Consequences include decreased quality of life, time off work and secondary depression.

This article outlines the aetiology, outcomes, history and examination of women with hyperemesis gravidarum. Treatment modalities are discussed together with evidence regarding use.

It is important to exclude other causes of nausea and vomiting such as urinary tract infection and thyrotoxicosis. Assessment of severity by checking for ketones is important as severity determines management. Management will include rehydration (intravenous or oral). Evidence is lacking regarding dietary and lifestyle recommendations but some women find them useful. Pyridoxine and metoclopramide (category A) are first line in treatment of hyperemesis gravidarum followed by prochlorperazine (category C), prednisolone (category A), promethazine (category C) and ondansetron (category B1). Benefit has been reported with the use of ginger. Evidence is mixed regarding acupressure and acupuncture.