HYPEREMESIS GRAVIDARUM

Excessive vomiting during pregnancy, associated with ketosis, dehydration and weight loss (>5% of pre-pregnancy
weight).

Cause

  • Not known but may be common in multiple and molar pregnancy

Clinical features

  • May occur from the 4th week of pregnancy and can continue beyond the 12th week
  • Defining symptoms are nausea and vomiting so severe that oral intake is compromised
  • Patient may develop complications of excessive vomiting, such as vomiting blood and dehydration

Differential diagnosis

  • Intestinal obstruction
  • Other causes of vomiting
  • Molar pregnancy

Investigations

  • Blood: complete count, RDT for malaria parasites
  • Urinalysis: to exclude urinary tract infection
  • Ultrasound scan: to detect molar or multiple pregnancies

MANAGEMENT

  • IV fluids to correct dehydration and ketosis (give Ringer’s lactate or Normal saline and Glucose 5%)
  • Promethazine 25 mg IM or orally every 8 hours prn
  • Vitamin B6 (Pyridoxine) 1 tablet every 12 hours for 7 days
  • Or Metoclopramide 10 mg IM or IV or orally every 6-8 hours prn and

If not responding to the above

  • Chlorpromazine 25 mg IM or orally every 6 hours prn and refer