Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that affects 1.2% of women. It is characterized by prolonged vomiting, weight loss, dehydration, and electrolyte disturbances. Risk factors include younger age, previous pregnancy, and female fetus. Treatment involves dietary changes, hydration, thiamine/vitamin B6 supplementation, and ginger. For severe cases, IV fluids, enteral nutrition, and pharmacotherapy with antihistamines and dopamine antagonists like metoclopramide may be used. Steroids are not recommended due to risks of fetal growth issues.

1. Kurdistan Board GEH/GIT SurgeryKurdistan Board GEH/GIT Surgery
Weekly J ClubWeekly J Club
Supervised by:Supervised by:
Dr. Mohamed AlshekhaniDr. Mohamed Alshekhani

2. Introduction:Introduction:
 The most common medical conditions during pregnancy; nausea /The most common medical conditions during pregnancy; nausea /
vomiting, nausea 50-80% ,vomiting 50%.vomiting, nausea 50-80% ,vomiting 50%.
 Hyperemesis gravidarum (HG) is a severe & persistent form ofHyperemesis gravidarum (HG) is a severe & persistent form of
nausea / vomiting,only affects 1.2% of pregnant women.nausea / vomiting,only affects 1.2% of pregnant women.
 Accepted definitions, combine the symptoms of protractedAccepted definitions, combine the symptoms of protracted
vomiting/nausea with : weight loss, ketonuria, electrolytevomiting/nausea with : weight loss, ketonuria, electrolyte
disturbances, dehydration/or hospitalization.disturbances, dehydration/or hospitalization.
 It is associated with a higher risk of negative pregnancy outcomes:It is associated with a higher risk of negative pregnancy outcomes:
preterm birth, low birth weight, small-for-gestational-age infants.preterm birth, low birth weight, small-for-gestational-age infants.
 Risk factors for HG include female gender infant, young maternalRisk factors for HG include female gender infant, young maternal
age, previous pregnancy, non-European heritage.age, previous pregnancy, non-European heritage.
 BMI, smoking& socioeconomic status are not risk factors for HG.BMI, smoking& socioeconomic status are not risk factors for HG.

3. HG:ManagementHG:Management
 Exclude other physiologic causes for nausea/vomitingExclude other physiologic causes for nausea/vomiting
 Nonpharmacologic trt:reassurance, dietary changes, lifestyleNonpharmacologic trt:reassurance, dietary changes, lifestyle
modifications,reduce stress , adequate rest.modifications,reduce stress , adequate rest.
 To prevent dehydration, daily consumption of 1 L - 1.5 L of eitherTo prevent dehydration, daily consumption of 1 L - 1.5 L of either
sports drinks or broth containing salt, glucose, potassium.sports drinks or broth containing salt, glucose, potassium.
 Diet recommendations include small, frequent meals ,avoidance ofDiet recommendations include small, frequent meals ,avoidance of
fatty foods , fresh vegetables that may delay gastric emptying orfatty foods , fresh vegetables that may delay gastric emptying or
have difficulty emptying from the stomac.have difficulty emptying from the stomac.
 High-protein liquid beverages reduce gastric dysrhythmias &High-protein liquid beverages reduce gastric dysrhythmias &
nausea in the first trimester.nausea in the first trimester.
 Thiamine (vitamin B1) / pyridoxine(vitaminB6) are efficacious inThiamine (vitamin B1) / pyridoxine(vitaminB6) are efficacious in
reducing nausea / vomiting.reducing nausea / vomiting.
 Zingiber officinale, the root of ginger effective by increase gastricZingiber officinale, the root of ginger effective by increase gastric
motility, stimulate gastric antral contractions,block the cholinergicmotility, stimulate gastric antral contractions,block the cholinergic
M receptors &serotonin receptor.

4. HG:ManagementHG:Management
 Management of HG may require intravenous fluids to correct orManagement of HG may require intravenous fluids to correct or
prevent dehydration/ restore electrolyte balance.prevent dehydration/ restore electrolyte balance.
 Additional nutritional support via NGT or enteral route may beAdditional nutritional support via NGT or enteral route may be
considered for those with severe, intractable symptoms and/orconsidered for those with severe, intractable symptoms and/or
weight loss in spite of appropriate therapy.weight loss in spite of appropriate therapy.
 Commonly used agents include phenothiazines, H receptorCommonly used agents include phenothiazines, H receptor
blockers&dopamine antagonists.blockers&dopamine antagonists.
 Oral histamine receptor blockers, such as over-the-counterOral histamine receptor blockers, such as over-the-counter
doxylamine, have proved efficacy&considered first-linedoxylamine, have proved efficacy&considered first-line
pharmacologic therapy in the treatment of pregnancy-associatedpharmacologic therapy in the treatment of pregnancy-associated
nausea / vomiting&teratogenic.nausea / vomiting&teratogenic.
 Phenothiazines, least safe in pregnancy.Phenothiazines, least safe in pregnancy.
 Ondansetron, 5-HT3 antagonist, particularly useful in the treatmentOndansetron, 5-HT3 antagonist, particularly useful in the treatment
of chemotherapy-induced nausea / vomiting,an increased risk ofof chemotherapy-induced nausea / vomiting,an increased risk of
congenital heart defects in the first trimester.congenital heart defects in the first trimester.

5. HG:ManagementHG:Management
 Metoclopramide, a dopamine antagonist, used in the treatment ofMetoclopramide, a dopamine antagonist, used in the treatment of
nausea/vomiting during pregnancy,not teratogenic &fewer sidenausea/vomiting during pregnancy,not teratogenic &fewer side
effects: less drowsiness, dizziness, dystonia.effects: less drowsiness, dizziness, dystonia.
 Steroids, relieve nausea via a central mechanism, are not routinelySteroids, relieve nausea via a central mechanism, are not routinely
recommended in pregnancy due to fetal growth impairment &recommended in pregnancy due to fetal growth impairment &
increased risk of cleft palate.increased risk of cleft palate.