Overview
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy (NVP) that can lead to significant maternal morbidity 3. It is characterized by persistent vomiting, weight loss, dehydration, and electrolyte imbalance 3.Diagnosis
Severity of NVP and HG can be classified using validated tools such as the Pregnancy-Unique Quantification of Emesis (PUQE) and HyperEmesis Level Prediction (HELP) tools 3.
Ketonuria is not an indicator of dehydration and should not be used to assess severity 3.Management
First-line antiemetics include H1-histamines, phenothiazines, and doxylamine/pyridoxine 3.
Ondansetron can be used as a second-line antiemetic if first-line options are ineffective 3.
Metoclopramide is safe and effective and can be used alone or in combination with other antiemetics, typically as second-line therapy due to the risk of extrapyramidal effects 3.
Intravenous metoclopramide should be administered by slow bolus injection over at least 3 minutes 3.
If adverse reactions to antiemetics occur, medications should be promptly stopped 3.
Intravenous fluid resuscitation may include normal saline with potassium chloride 3.Key Recommendations
Utilize objective and validated indices like PUQE and HELP to classify the severity of NVP and HG 3. (Evidence: Moderate)
Prescribe first-line antiemetics such as H1-histamines, phenothiazines, and doxylamine/pyridoxine when required for NVP and HG 3. (Evidence: Strong)
Do not discourage the use of ondansetron as a second-line antiemetic if first-line options are ineffective, balancing the small absolute risk of orofacial clefting with the risks of poorly managed HG 3. (Evidence: Moderate)References
1 von Kaisenberg C, Kozlowski P, Kagan KO, Hoopmann M, Heling KS, Chaoui R et al.. Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation - Part 2. Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2025. link
2 von Kaisenberg C, Kozlowski P, Kagan KO, Hoopmann M, Heling KS, Chaoui R et al.. Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation - Part 1. Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2025. link
3 Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K et al.. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG : an international journal of obstetrics and gynaecology 2024. link