Hyperemesis gravidarum

Hyperemesis gravidarum-

Hyper- Excessive

Emesis- Vomit


Hyperemesis gravidarum refers to excessive nausea and vomiting that results in fluid and electrolyte imbalance, nutritional deficits, marked weight loss occurring in up to 1 percent of pregnant women and begins before the 20th weeks of pregnancy. Earlier it used to be a contributing factor for maternal mortality.


  1. It remains obscure. However certain facts and theories are known:
  2. Unknown
  3. Nulliparity
  4. Smoking              
  5. It occurs frequently among young obese primigravidas in multifoetal gestation and in trophoblastic diseases. It tends to recur in subsequent pregnancies.
  6. Theories-
  • Hormonal- Excess of chorionic gonadrophin and progesterone.
  • Psychogenic
  • Deficiency of Vitamin B and disturbance of carbohydrate metabolism.
  • Allergic

Clinical Manifestations

  • Evidences of starvation and malnutrition.
  • Nausea and vomiting are increased.
  • Oral feeds are intolerable.
  • Oliguria
  • Epigastric pain
  • Constipation
  • Fatigue
  • Dry coated tongue
  • Sunken eyes
  • Ketosis
  • Progressive emaciation with dehydration and weight loss.
  • Mild pyrexia, tachycardia, breath becomes acetone smell and systolic blood pressure falls below 100 mm of Hg.


  • History
  • Clinical Features
  1. Urine analysis for volume, colour, specific gravity, pigments and appearance of acetone.
  2. Estimates of blood value — Haematocrit, Electrolyte levels.
  3. Thyroid function test
  4. Ultrasound scan

Nursing Goals

  • Reducing and eliminating nausea and vomiting
  • Restoring fluid and electrolyte balance
  • Coping with the psychological tasks of pregnancy and motherhood
  • Continuing foetal growth and development.

Nursing Interventions

  • Obtain history for accessing pattern of nausea and vomiting
  • A complete physical examination about fluid and electrolyte imbalance, nutritional status and signs of complications such as metabolic acidosis and jaundice.
  • Administration of parenteral and enteral fluids and electrolytes and antiemetics.
  • Maintain observation chart.
  • Encourage patient to sit upright after meal.
  • Provide a hygienic, restful and odourless environment.
  • Check for elimination especially bowel movement and maintain intake and output chart.
  • When there is response to therapy start with limited oral fluids and carbohydrate foods like biscuits, bread and toast.
  • Monitor maternal and foetal well-being.


  • Dehydration-Electrolyte imbalance, renal failure
  • Wernicke’s Encephalopathy (Thiamine deficiency)
  • Vitamin K deficiency- maternal coagulopathy or fetal intracranial haemorrhage
  • Mallory Weiss tears- Characterized by upper gastro-intestinal bleeding secondary to longitudinal mucosal lacerations at the gastroesophageal junction or gastric cardia.
  • Boerhaave syndrome- Characterized by upper gastrointestinal bleeding secondary to transmural perforation of the esophagus (Boerhaave syndrome is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to relax.)