Hyperemesis gravidarum

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Background

  • Simple nausea and vomiting affects 60-80% of patients during first 12wk of pregnancy
  • Hyperemesis gravidarum only affects 0.3-2% of pregnancies[1]

Clinical Features

  • Persistent nausea and vomiting
  • Signs of volume depletion
  • Note: Abdominal pain is highly unusual and should prompt consideration of a different diagnosis

Differential Diagnosis

Nausea and vomiting in pregnancy

Evaluation

Workup

Diagnosis

Defined as intractable vomiting with at least 1 of following:

Management

Antiemetics

ACOG recommends a stepwise approach to nausea and vomiting in pregnancy[2]

Medication Pregnancy Drug Class
Vitamin B6 A
Dimenhydrinate B
Doxylamine A
Ondansetron C
Metoclopramide B
Promethazine C

Rehydration

  • PO fluids if able to tolerate
  • IV fluids (use fluid containing D5 in the setting of ketonuria)

Disposition

  • Discharge if able to tolerate PO and ketonuria resolved

Admit

References

  1. Goodwin, TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am. 2008 Sep;35(3):401-17
  2. Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 153. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015; 126(3):e12-24
  3. Fejzo MS, et al. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod Toxicol. 2016 Jul;62:87-91.