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Hyperemesis Gravidarum

Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Hyperemesis gravidarum is persistent vomiting in a pregnant woman that interferes with fluid and electrolyte balance as well as nutrition:

    • Usually associated with the first 8 to 20 we...

DIAGNOSIS

HISTORY

  • Hypersensitivity to smell

  • Alteration in taste

  • Excessive salivation

  • Poor appetite

  • Nausea

  • Vomiting with retching

  • Decreased urine output

  • Fatigue

  • Dizziness with standing

DIAGNOSTIC TESTS & INTERPRETATION

TREATMENT

Pyridoxine and doxylamine (pregnancy Category A) are first-line treatments for hyperemesis gravidarum (1)[C]. This is followed by metoclopramide or ondansetron (pregnancy Category B) and the...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Activity as tolerated after improvement

  • Overall quality of life and future fertility plans can be impacted by severity of nausea and vomiting (6)[B].

Patient Monitoring

REFERENCES

1
Maltepe C, Koren G. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum—a 2013 update. J Popul Ther Clin Pharmacol.  2013;20(2):e184–e192. [View Abstract on ...

ADDITIONAL READING

  • Abas MN, Tan PC, Azmi N, et al. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol.  2014;123(6):1272–1279. [Vie...

CODES

ICD10

  • O21.9 Vomiting of pregnancy, unspecified

  • O21.0 Mild hyperemesis gravidarum

  • O21.1 Hyperemesis gravidarum with metabolic disturbance

  • O21.2 Late vomiting of pregnancy

  • O21.8 Other vomiting complica...

CLINICAL PEARLS

  • Do not allow patients to become volume depleted. Once this occurs, it is more difficult to interrupt the process.

  • Do not be hesitant to use medications to assist the patient because thi...

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