Hyperemesis Gravidarum

Hyperemesis gravidarum is a condition of pregnant women in which intractable vomiting early in gestation causes dehydration, electrolyte disturbances, and/or nutritional deficiencies with accompanying weight loss. Also known as the "pernicious vomiting of pregnancy," hyperemesis gravidarum occurs in approximately 3.5 per 1000 pregnancies. Hyperemesis gravidarum is more common in primigravidas; younger women, especially those less than 20 years of age; women with less than 12 years of education; obese women; and nonsmokers. Multiple gestations and the presence of trophoblastic disease also appear to predispose to this disorder. Though generally a self-limited condition, the natural history of hyperemesis gravidarum is one of slow recovery with frequent relapses. Fluid, electrolyte, and nutritional derangements can lead to renal and hepatic dysfunction. Other associated disturbances include neurologic abnormalities, retinal hemorrhage, Mallory-Weiss tear, and acid aspiration syndrome.

The treatment of hyperemesis gravidarum is generally supportive and includes reassurance, small frequent meals, restricting the amount of fat and indigestible material in meals, and encouraging intake of carbohydrates. For severe or refractory cases, parenteral hyperalimentation may be required. The most effective way to judge recovery is not only by cessation of vomiting and correction of fluid and electrolyte abnormalities, but also by weight stabilization and weight gain.