top of page

Hyperemesis Gravidarum (HG)

Hyperemesis Gravidarum (HG) is a b-hCG related condition, therefore conditions that increase b-hCG will worsen the severity of HG. The main risk factor for this is an increased placental mass, which can be due to multiple pregnancies or molar pregnancy.

  • Multiple pregnancies is physiological therefore HG isn’t unexpected, but molar pregnancy is pathological and needs to be excluded


Other risk factors - First pregnancy, Overweight/obese, Hx or Family Hx

A rare, but important complication here is Wernicke’s encephalopathy as there could be a loss of Thiamine from the prolonged vomiting.

ree

Diagnosis

For a diagnosis, it needs to occur in the 1st trimester (< 12 weeks), and other causes need to be excluded first. Its diagnositc criteria are:

  • Prolonged, persistent, severe N+V unrelated to other causes

    • If it occurs after 11/12 weeks and is less prolonged, other causes like gastroenteritis should be considered

  • Weight loss (>5% than pre-pregnancy weight)

  • Dehydration and electrolyte imbalance


The PUQE’s scoring system is used to assess its severity:

ree

Management

N.B. Nothing given orally as the patient will be vomiting it all out.


  • Antiemetics - 1st lines are Cyclizine, Metoclopramide, Prochlorperazine

  • IVF w/Potassium

  • Thiamine to prevent Wernicke’s


N.B. Ginger has been shown to be useful in reducing symptoms.


An important side-effect to remember for Metoclopramide is acute dystonia (extra-pyramidal side-effect). Due to its antagonism at the D2 receptor, it can also cause block the extra-pyramidal circuits, leading to the side-effects of acute dystonia and tardive dyskinesia. This is same mechanism in which antipsychotics cause their side-effects.



bottom of page