Hyperemesis Gravidarum SSOU Guideline
Definition
Excessive and persistent nausea and vomiting during early pregnancy causing dehydration
Admission Criteria
- Presumed normal pregnancy
- Vomiting requiring IV hydration
- No evidence of miscarriage
- No evidence of pre-eclampsia
- Other diagnosis unlikely (eg UTI, surgical abdomen)
- Normal urinalysis
Exclusion Criteria
- Diagnosis unclear
- Abdominal pain/ tenderness unrelated to vomiting
- Urinary symptoms
- PV bleeding
- Fever
- > 20 weeks gestation
BP>140/90 and proteinuria or symptoms of possible pre-eclampsia (seizure, headache, blurred vision, abdominal pain)
Investigations
- FBE
- UEC
- Glucose
- LFT
- MSU/Urinalysis
- Consider ultrasound for twin or molar pregnancy if indicated
Suggested Medications
Drug Dose Frequency Route Normal Saline 1 litre over 1 hour Repeat 2 or 3 times IVI Ondansetron 4mg-8mg 8-12 hourly prn SL/IV Metaclopramide 10mg 6/24 IV Consider Vitamin B6, accupressure, ginger, first generation antihistamines like proethazine. Specific Observations
- Report PV bleeding
- Report increasing abdominal pain
- Report elevated BP, altered conscious state, headache, blurred vision
Specific Management Issues
Discharge Criteria
- No vomiting for 6 hours
- Hydration restored
- Able to tolerate some oral fluids
- Adequate social supports and follow up
Hospital Admission Criteria