Hyperemesis Gravidarum Treatment in Indore

Hyperemesis gravidarum:

HG is a severe form of nausea and vomiting during pregnancy, far beyond the normal “morning sickness.”

It can cause dehydration, electrolyte imbalance, malnutrition, and weight loss, which in turn may also require medical intervention.

ICD-10 Code: O21.1

Onset: Usually starts in the first trimester: weeks 4–10

Duration: May continue throughout pregnancy, but often improves after 20 weeks

⚕️ Difference Between Morning Sickness and HG

Feature/Morning Sickness/Hyperemesis Gravidarum

Frequency of vomitingOccasionalPersistent (several times daily)

Weight loss Minimal >5% of pre-pregnancy weight

Dehydration No Yes

Need for hospitalization\tRare\tCommon

Impact on daily life为空Mild to moderate MEDSevere, disabling

Causes and Risk Factors

The exact cause is not fully understood, but a number of factors are believed to contribute:

1. Hormonal Factors

Human Chorionic Gonadotropin (hCG): High levels correlate with HG.

Estrogen and progesterone may slow gastric motility and further contribute to nausea.

2. Genetic Predisposition

Family history of HG increases the risk.

Recurrence in subsequent pregnancies is common.

3. Gastrointestinal Factors

Helicobacter pylori infection has been suggested to play a role in some.

4. Psychological Factors

Previously thought to be psychogenic, but now thought to be secondary to physiological causes. Stress may exacerbate symptoms.

5. Other Risk Factors

• First pregnancy

• Multiple gestations (twins, triplets)

• Molar pregnancy

• Female fetus

• Obesity

• Hyperthyroidism

⚠️ Signs and Symptoms

Typical symptoms include:

Severe and persistent nausea and vomiting

Inability to keep food or fluids down

Weight loss of >5% of pre-pregnancy body weight

Dehydration: dry mouth, sunken eyes, decreased urine output

Fatigue and dizziness

Ketonuria-starvation ketones in the urine

Electrolyte imbalances, especially low potassium

Tachycardia, hypotension

Diagnosis

Diagnosis is clinical, supported by laboratory findings.

Diagnostic Criteria:

Persistent vomiting not due to other causes

Weight loss >5% of pre-pregnancy weight

Ketonuria or ketonemia

Electrolyte imbalance: ↓Na⁺, ↓K⁺, ↑Hct

Absence of other medical conditions causing vomiting (e.g., hepatitis, UTI)

Investigations

Urinalysis: Ketonuria, specific gravity ↑

Blood tests: electrolyte disturbances, increased hematocrit, renal function

Thyroid tests: to exclude thyrotoxicosis

Ultrasound: exclude multiple or molar pregnancy

Treatment and Management

1. Supportive Therapy

Hospitalization if severe dehydration or weight loss

IV fluids: Normal saline with potassium supplementation

Electrolyte correction

Vitamin replacement: Thiamine (B1) prior to glucose for prevention of Wernicke’s encephalopathy

2. Nutritional Support

Small, frequent meals

Avoidance of triggers: strong odors, spicy/fatty foods

Dry foods (toast, crackers)

High-protein snacks

In severe cases: enteral-nasogastric or parenteral nutrition

3. Pharmacologic Treatment

(Given under medical supervision)

Drug Class Examples Notes

Antiemetics Metoclopramide, Ondansetron, Promethazine First-line or second-line therapy

Antihistamines Doxy-lamine, Diphenhydramine Commonly used

Vitamin B6 (Pyridoxine) 10–25 mg every 8 hrs Safe and effective

Corticosteroids & Methylprednisolone & For refractory cases only

Ginger supplements Natural remedy May reduce mild nausea

Complications

Maternal:

Severe dehydration and electrolyte imbalance

Wernicke’s encephalopathy due to thiamine deficiency

Mallory-Weiss tear (esophageal tear due to vomiting)

Psychological stress and depression

Liver and kidney dysfunction

Fetal:

Intrauterine growth restriction (IUGR)

Low birth weight

Preterm delivery

Rarely, fetal demise if severe malnutrition persists

Prevention and Self-Care Measures

Although it is not always possible to prevent HG, early recognition and management can lessen its severity.

Preventive Strategies

Preconception care:

Treat any underlying gastrointestinal or thyroid disorders.

Ensure good nutritional status before conception.

Early pregnancy care:

Start vitamin B6 and prenatal vitamins before conception or early in pregnancy.

Avoid strong odours and foods that provoke nausea.

Eat small, frequent meals; don’t let the stomach get empty.

Take small sips of fluids throughout the day to stay hydrated.

Adequate rest and stress management.

Monitor early symptoms:

If vomiting is persistent, or early weight loss occurs, consult a physician. Prognosis Most women improve by 20 weeks of gestation. Symptoms may repeat in later pregnancies. Maternal and fetal outcomes are usually good, provided there is proper management.