Hyperemesis Gravidorum or Morning Sickness

Many women have nausea in early pregnancy and it is mild and generally self-limiting. Women are usually advised to avoid spicy or fried and eat “little and often” – trying to keep down dry foods. Ginger has often been said to be helpful and certainly there is no harm in trying this. There is also some evidence to suggest acupuncture may have an impact in some cases. Hydration is important. It is usual to check the urine for ketones and and take blood to check for liver disease – but this is unusual.

In the event of “moderate” HG – more supportive therapy is needed. This takes the form of anti-emetic drug treatment and the use if intravenous fluids to maintain hydration. Both these can usually now be managed on an outpatient basis – with the women coming in to a day care facility for the intravenous fluids before going home. A variety of anti-emetics may be used as first line treatment – promethazine (25 mg 4 to 6 hourly) and metoclopramide (10 mg four times a day) are the ones generally advised – and they are safe to use in pregnancy. If these do not work then Odansetron (4mg 6 hourly) may be substituted. In terms of intravenous fluid – and isotonic (essentially salt or similar solution should be used, and this should be supplemented by Thiamine and Folic acid.

During intravenous treatment blood tests need to be taken to check electrolytes (sodium, potassium levels etc). Finally if there is no response a trial of steroid treatment can be given – as trials have shown that this works. If there is still no response after 4 to 5 days consideration needs to be given to more intrusive supportive management.

Generally the situation will be stabilised as an outpatient – however occasionally the condition is severe enough to merit admission to hospital. This may involve better management of fluids and nursing care – but may if there is no resolution involve feeding using a naso-gastric tube or even enteral nutrition. However it must be emphasised that these cases are rare.
There is no doubt that HG is very unpleasant – however in the majority this is a self limiting condition that settles after relatively minor treatment or a short stay in hospital. The emphasis now is very much on outpatient management whereas not that long ago admission was the norm.

Professor Tom Bourne Ph.D., FRCOG
Consultant Gynaecologist
Queen Charlotte’s and Chelsea Hospital, Imperial College NHS Trust, London,  and  University Hospital, KU Leuven. Belgium