Severe Vomiting In Pregnancy / Hyperemesis Gravidarum (HG)!

Severe vomiting in pregnancy/hyperemesis gravidarum (hg)

• It is characterized by severe nausea, vomiting, weight loss, and possibly dehydration. Signs and symptoms may also include vomiting many times a day and feeling faint. Hyperemesis gravidarum is considered more severe than morning sickness. Often symptoms get better after the 20th week of pregnancy but may last the entire pregnancy duration.
• It is technically defined as more than three episodes of vomiting per day such that weight loss of 5% or three kilograms has occurred and ketones are present in the urine

Risk factors
Include the first pregnancy, multiple pregnancies, obesity, prior or family history of hg, trophoblastic disorder, and a history of eating disorders

Signs and symptoms
When vomiting is severe, it may result in the following

• Loss of 5% or more of pre-pregnancy body weight
• Dehydration causing ketosis 
• Constipation
• Nutritional disorders such as vitamin b1/b6/b12 deficiency
• Metabolic imbalances/ electrolyte imbalance
• Physical and emotional stress
• Difficulty with daily activities

Investigations
Common investigations include bun and electrolytes, liver function tests, urinalysis, and thyroid tests. Hematological investigations include hematocrit levels, which are usually raised in hg. An ultrasound may be needed to know gestational status and to exclude molar or partial molar pregnancy

Management
Dry bland food and oral rehydration are first-line treatments. Due to the potential for severe dehydration and other complications, HG is treated as an emergency. If conservative dietary measures fail, more extensive treatment such as the use of antiemetic medications and intravenous rehydration may be required. If oral nutrition is insufficient, intravenous nutritional support may be needed.