Hyperemesis Gravidarum

Excerpt

Hyperemesis gravidarum represents the severe end of the spectrum of nausea and vomiting of pregnancy, a condition that affects the majority of pregnant individuals to varying degrees. However, unlike mild nausea and vomiting of pregnancy, which typically begins shortly after a missed menstrual period, peaking between 8 and 12 weeks of gestation, and improves as pregnancy progresses into the second trimester, hyperemesis gravidarum is characterized by persistent vomiting, significant weight loss (typically ≥5% of prepregnancy weight), dehydration, and metabolic disturbances and is a leading cause of early pregnancy hospitalization. Hyperemesis gravidarum is most often diagnosed clinically by exclusion of differential diagnoses and supported by signs, including ketonuria, orthostatic hypotension, and electrolyte imbalances. Complications may include Wernicke encephalopathy and other nutritional deficiencies.

Hyperemesis gravidarum has no universal standard for diagnosing or admitting patients for inpatient care, leading many individuals to undergo multiple outpatient visits before receiving hospital treatment. Admission is generally recommended for patients unable to tolerate oral intake, those unresponsive to oral antiemetics, or when laboratory abnormalities or comorbid conditions necessitate closer monitoring.

Initial inpatient management focuses on stabilizing the patient through aggressive intravenous (IV) fluid therapy and correcting electrolyte abnormalities. Thiamine and multivitamin supplementation are crucial to prevent neurological complications. Antinausea medications are primarily administered intravenously, with options tailored to the patient’s response and medical history. Despite treatment, recurrence is common, with a significant proportion of patients requiring multiple admissions. This condition can significantly impact the quality of life of women and their families and, unfortunately, may be very challenging to treat. Therefore, early recognition and proactive management are essential to improve maternal and fetal outcomes.