Hyperemesis gravidarum affects 0.3-3% of pregnancies depending on the population studied. Nausea and vomiting typically onset at 5-6 weeks gestation, and if onset is at > 9 weeks alternative diagnoses such as preeclampsia, HELLP, and acute fatty liver of pregnancy should be ruled out. Conservative management for mildly affected patients includes switching prenatal vitamins to folic acid only, ginger supplements, and acupressure wrist bands. More severely affected patients (weight loss, inability to tolerate any PO, evidence of dehydration) should have urine specific gravity and ketones and serum electrolytes checked and receive IV fluids. Depending on prior care, ultrasound to rule out molar or multiple gestation may be warranted. First-line pharmacologic therapy is pyridoxine and doxylamine.
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April 23, 2020 at 12:58 am
Hyperemesis gravidarum affects 0.3-3% of pregnancies depending on the population studied. Nausea and vomiting typically onset at 5-6 weeks gestation, and if onset is at > 9 weeks alternative diagnoses such as preeclampsia, HELLP, and acute fatty liver of pregnancy should be ruled out. Conservative management for mildly affected patients includes switching prenatal vitamins to folic acid only, ginger supplements, and acupressure wrist bands. More severely affected patients (weight loss, inability to tolerate any PO, evidence of dehydration) should have urine specific gravity and ketones and serum electrolytes checked and receive IV fluids. Depending on prior care, ultrasound to rule out molar or multiple gestation may be warranted. First-line pharmacologic therapy is pyridoxine and doxylamine.