Hyperemesis gravidarum


  • Lana Jaram Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Matea Drlje Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Nikolina Friščić Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Vlatka Jozanović Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb
  • Vladimir Blagaić Department of Gynecology and Obstetrics, Clinical Hospital „Sveti Duh“, Zagreb




nausea, vomiting, pregnancy, hyperemesis gravidarum


Hyperemesis gravidarum (HG) is defined as a severe form of Nausea and Vomiting of Pregnancy (NVP) and is characterized by nausea and excessive vomiting that can start as early as the 6th week of pregnancy, and last up to the middle of the second trimester. No definitive diagnostic criteria exist that could exactly differentiate HG from NVP, but in clinical practice loss of >5% of body mass as a result of vomiting and loss of appetite is considered a clear sign of the disorder. Pregnant women with HG can also have other gastrointestinal, metabolic and neurological symptoms, so it is important to rule out other possible causes of vomiting in pregnancy. Since the disorder is self-limiting, the primary aim of the treatment is to manage the symptoms and avoid possible complications due to hypovolemia and malnutrition. The therapeutic approach can be nonpharmacological in milder cases, but in severe cases, vitamin B6 (pyridoxine) in combination with doxylamine has proven to be the most effective therapy.


1. Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of pregnancy - What's new? Autonomic neuroscience : basic & clinical. 2017; 202: 62-72. doi: 10.1016/j.autneu.2016.05.002.
2. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Human reproduction update. 2005; 11 (5): 527-539. doi: 10.1093/humupd/dmi021.
3. Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterology clinics of North America. 2011; 40 (2): 309-334, vii. doi: 10.1016/j.gtc.2011.03.009.
4. Klebanoff MA, Koslowe PA, Kaslow R, Rhoads GG. Epidemiology of vomiting in early pregnancy. Obstetrics and gynecology. 1985; 66 (5): 612-616.
5. Tan PC, Jacob R, Quek KF, Omar SZ. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG : an international journal of obstetrics and gynaecology. 2006; 113 (6): 733-737. doi: 10.1111/j.1471-0528.2006.00947.x.
6. Fejzo MS, Ching C, Schoenberg FP, Macgibbon K, Romero R, Goodwin TM, Mullin PM. Change in paternity and recurrence of hyperemesis gravidarum. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2012; 25 (8): 1241-1245. doi: 10.3109/14767058.2011.632039.
7. Zhang Y, Cantor RM, MacGibbon K, Romero R, Goodwin TM, Mullin PM, Fejzo MS. Familial aggregation of hyperemesis gravidarum. American journal of obstetrics and gynecology. 2011; 204 (3): 230 e231-237. doi: 10.1016/j.ajog.2010.09.018.
8. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. The New England journal of medicine. 2010; 363 (16): 1544-1550. doi: 10.1056/NEJMcp1003896.
9. Kimura M, Amino N, Tamaki H, Ito E, Mitsuda N, Miyai K, Tanizawa O. Gestational thyrotoxicosis and hyperemesis gravidarum: possible role of hCG with higher stimulating activity. Clinical endocrinology. 1993; 38 (4): 345-350. doi: 10.1111/j.1365-2265.1993.tb00512.x.
10. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. American journal of obstetrics and gynecology. 2000; 182 (4): 931-937. doi: 10.1016/s0002-9378(00)70349-8.
11. Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, Goodwin TM. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. Journal of women's health (2002). 2009; 18 (12): 1981-1987. doi: 10.1089/jwh.2009.1431.
12. Berdai MA, Labib S, Harandou M. Wernicke's Encephalopathy Complicating Hyperemesis during Pregnancy. Case reports in critical care. 2016; 2016: 8783932. doi: 10.1155/2016/8783932.
13. Godsey RK, Newman RB. Hyperemesis gravidarum. A comparison of single and multiple admissions. The Journal of reproductive medicine. 1991; 36 (4): 287-290.
14. Bottomley C, Bourne T. Management strategies for hyperemesis. Best practice & research Clinical obstetrics & gynaecology. 2009; 23 (4): 549-564. doi: 10.1016/j.bpobgyn.2008.12.012.
15. Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, Navioz Y, Ungar WJ. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2005; 25 (3): 241-244. doi: 10.1080/01443610500060651.
16. Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG : an international journal of obstetrics and gynaecology. 2017; 124 (1): 20-30. doi: 10.1111/1471-0528.14180.
17. Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG : an international journal of obstetrics and gynaecology. 2011; 118 (11): 1302-1313. doi: 10.1111/j.1471-0528.2011.03023.x.
18. Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study. Obstetrics and gynecology. 1991; 78 (1): 33-36.
19. Anderka M, Mitchell AA, Louik C, Werler MM, Hernandez-Diaz S, Rasmussen SA, National Birth Defects Prevention S. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth defects research Part A, Clinical and molecular teratology. 2012; 94 (1): 22-30. doi: 10.1002/bdra.22865.
20. Oliveira LG, Capp SM, You WB, Riffenburgh RH, Carstairs SD. Ondansetron compared with doxylamine and pyridoxine for treatment of nausea in pregnancy: a randomized controlled trial. Obstetrics and gynecology. 2014; 124 (4): 735-742. doi: 10.1097/aog.0000000000000479.
21. Rodriguez-Pinilla E, Martinez-Frias ML. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology. 1998; 58 (1): 2-5. doi: 10.1002/(sici)1096-9926(199807)58:1<2::aid-tera2>3.0.co;2-4.




How to Cite

Jaram, L., Drlje, M., Friščić, N., Jozanović, V., & Blagaić, V. (2019). Hyperemesis gravidarum. BioMedicine and Surgery, 1(4), 159–161. https://doi.org/10.5281/zenodo.3593282