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Hyperemesis Gravidarum, Emergency Medicine

David Della- Giustina Reviewed 06/2017
 


Basics

Description

  • Hyperemesis gravidarum is the most severe form along the continuum of nausea and vomiting of pregnancy

  • Also known as pernicious vomiting of pregnancy

  • Characterized by unexplained intra...

Diagnosis

Signs and Symptoms

  • Nausea and vomiting during pregnancy affects between 50% and 90%

  • Onset of symptoms by the 4th–10th wk of pregnancy with resolution by the 20th:

    • Symptoms after the 20th wk sho...

Treatment

Pre-Hospital

  • IV, monitor if signs of significant volume depletion

  • IV hydration

Initial Stabilization/Therapy

IV hydration using a crystalloid solution (LR or NS) 

Ed Treatment/Procedures

  • IV hydrat...

Follow-Up

Disposition

Admission Criteria

  • Inability to tolerate oral intake after treatment

  • Inability to control the emesis despite treatment

  • Severe electrolyte or metabolic disturbances

  • At highest risk ...

Pearls and Pitfalls

  • Other diagnoses should be explored in patients presenting after 9 wk gestation with nausea and vomiting as initial symptoms

  • The use of PICC lines has been shown to carry significant...

Additional Reading

  • Bottomley  C, Bourne  T. Management strategies in hyperemesis. Best Prac Res Clin Obstet Gynaecol.  2009;23:549–564.

  • Goodwin  TM. Hyperemesis gravidarum. Obstet Gynecol Clin Nor...

Codes

ICD9

  • 643.00 Mild hyperemesis gravidarum, unspecified as to episode of care or not applicable

  • 643.10 Hyperemesis gravidarum with metabolic disturbance, unspecified as to episode of care or not appl...

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