Clinical Case Database / Category: Patient Management

Hyperemesis Gravidarum

Publication details

Dr Thirumagal Bavananthan, Mrs Swati Ghosh, Dr Benjamin Miguras
Foundation Years Journal, volume 8, issue 9, p.34 (123Doc Education, London, October 2014)


Nausea and vomiting in pregnancy is a common symptom that can cause considerable psychosocial and financial implications but rarely causes morbidity and mortality. This is a common complaint requiring admission in Gynaecology through accident and emergency department and hyperemesis gravidarum is an over-diagnosis in this group. Hyperemesis results in dehydration, metabolic and electrolyte disturbance with increased risk of maternal and fetal morbidity. The pathophysiology is not fully understood but pregnancy hormone fluctuations are thought to play a role. Fluid rehydration and electrolyte replacement with antiemetics are the mainstay of treatment.

The case study described here is a common case scenario encountered by junior doctors. The discussion covers the important aspects in detail which includes history taking, physical examination, differential diagnosis, necessary investigations, management and complications of hyperemesis.

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Dr Thirumagal Bavananthan

Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB

Mrs Swati Ghosh

Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB

Dr Benjamin Miguras

Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB


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5. Hyperemesis education and research: Potential fetal complications. April 2013.
6. Hyperemesis gravidarium - management guideline, Worcestershire Acute Hospital Trust, WAHT-GYN-005, published 07/11/2012.
7. Wood P, Murray A, Sinha B et al. Wernicke's encephalopathy induced by hyperemesis gravidarum.British Journal of Obstetrics and Gynaecology 1983; 90: 583-586.
8. Novak D. et al, Nutrition in early life. How important is it? Clinics in Perinatology 2002 Jun;29(2):203-23.
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10. Subramaniam R et al,Total parenteral nutrition (TPN) and steroid usage in the management of hyperemesis gravidarum. Aust N Z J Obstet Gynaecol 1998;38:339â€"41.
11. Trogstad LI et al, Recurrence risk in hyperemesis gravidarum. BJOG 2005; Dec; 112(12):1641-5.


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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