Overview

• Severe form of nausea and vomiting in pregnancy, experienced by 1% of women. Most common between 8-12 weeks, but may persist until week 20.
• Diagnosis (WED) → ≥5% pre-pregnancy weight loss + dehydration + electrolyte imbalance.
  • In the absence of ketonuria, clinical dehydration, electrolyte imbalance, and less than 5% pre-pregnancy weight loss, the term nausea and vomiting of pregnancy is used.
• Risk Factors → increased levels of bHCG [multiple pregnancies, trophoblastic disease (molar pregnancy)], nulliparity, obesity.
  • Smoking is protective (associated with decreased incidence).

Making Diagnosis

Clinical Features

• Severe vomiting and inability to tolerate food and fluids.

Investigations

• Body Weight.
• Pregnancy-Unique Quantification of Emesis (PUQE) score → assess severity, gives score out of 15. <7/15 = mild, 7-12/15 = moderate, >12/15 = severe.
  • PUQE Scoring System
• U&E’s → hypokalaemia and hyponatraemia.
• Severe hyperemesis gravidarum patients presenting in early pregnancy before a dating scan should have an immediate ultrasound in the Early Pregnancy Unit due to the potential of abnormal trophoblastic diseases like molar pregnancy or choriocarcinoma.

Management Plan

• Simple Measures → rest and avoid triggers, eat bland/plain food (esp. in morning), ginger, acupressure on wrist at PC6 point.
• 1st Line Medications → antihistamines (oral cyclizine or promethazine).
  • Cyclizine → taken as 50mg tablets, up to 3 times daily.
• 2nd Line Medications → antiemetics (oral ondansetron or prochlorperazine).
  • Ondansetron → during the first trimester is associated with a small increased risk of the baby having a cleft lip/palate.
  • Metoclopramide → may cause extrapyramidal side effects, it should therefore not be used for more than 5 days.