Hyperemesis gravidarum

Hyperemesis gravidarum

Nausea and vomiting are often most pronounced in
the first trimester, but by no means confined to it, and
are also erroneously referred to as morning sickness.
It is worse in a molar or multiple gestation and is
probably related to high circulating human chorionic
gonadotrophin (hCG) levels. 


Severe symptoms may
lead to Mallory-Weiss tears, haematemesis, dehydration
and even malnutrition. 


In this situation, admission
to hospital is mandatory and anti-emetics such as
metoclopramide or prochlorperazine are given on a
regular basis. 


In addition, intravenous hydration
support should be administered as long as the woman
is vomiting. 


In the severest cases, total parenteral
nutrition (TPN) is given, and parenteral B complex
vitamins including thiamine are reported to reduce
the mortality of the condition. 


A tapering course of
steroids has been used with encouraging results in
uncontrolled studies. 


In the very worst cases, term in -
ation of pregnancy may be considered if the mother is
becoming malnourished and dehydrated.