• Hyperemesis Gravidarum SSOU Guideline


    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)



    • 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

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