Hyperemesis Gravidarum

Nause and Vomiting in pregnancy is common, usually occurs upto 16 weeks of pregnancy. Such problems are usually dealt conservatively by :

a) Eating small meals in frequent intervals
b) Avoid food that precipitates/aggravates symptoms

However, when it's prolonged, severe, frequent, intractable, not responding towards conservative management as mentioned above, and it's severe to the extent of causing dehydration, alkalosis and hypokalemia, it is known as Hyperemesis Gravidarum.

Nowadays, neurological complications of Hyperemesis Gravidarum is rare, more common complications are : Mallory-Weiss Tear and Esophageal rupture

It is more common in :

1) Multiple pregnancy
2) Molar pregnancy
3) Presence of UTI

Investigations

FBC, BUSE, Daily urinary ketones, MSU culture, if recurrent - TSH and T4 evaluation, and USG - to rule out multiple and molar pregnancy 

How do you manage it?

For moderate symptoms and signs (without dehydration) -> reassurance, reduce fear of pregnancy, adequate rest

For severe cases (with dehydration) :

a) Admit the patient
b) I/O chart
c) Administer IV Prochloperazine 12.5 mg tds
d) Give vitamin B complex and folic acid
e) IV fluid regime :

Calculate the percentage dehydration

Give 2 pints of Hartmann's + 2 pints of dextrose 10% + 2 pints of normal saline over 24 hours

Strict I/O chart

Allow oral intake as tolerable

f) If oral intake is non-tolerable, parental vitamins can be given in selected patients

g) If problem persist even with optimal treatment -> refer medical/psychiatric

Category: Obstetrics Notes