Excessive nausea and vomiting in pregnancy, often accompanied by dehydration and electrolyte imbalance with >5% pre-pregnancy weight loss

RCOG:

• Nausea and vomitting of pregnancy (NVP) - Describes troublesome Sx
• Hyperemesis gravidarum - Extreme form of this condition, associated with weight loss and ketonuria

Aetiology

It occurs in around 1% of pregnancies and is thought to be related to raised beta hCG levels. Hyperemesis gravidarum is most common between 8 and 12 weeks but may persist up to 20 weeks*.

Associations

• multiple pregnancies
• trophoblastic disease
• hyperthyroidism
• nulliparity
• obesity

Smoking is associated with a decreased incidence of hyperemesis.

Referral criteria for nausea and vomiting in pregnancy

NICE Clinical Knowledges Summaries recommend considering admission in the following situations:

• Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
• Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics