Our patient was a 34-year-old woman, G4P1.

Her first two

pregnancies ended with a spontaneous abortion at three months;
her next pregnancy ended at 32 weeks, and resulted in a live
male child. Her current pregnancy was at 23 weeks gestational
age. During this pregnancy, the patient experienced extreme
nausea and vomiting since week 2 of pregnancy and was
officially diagnosed with HG at week 6 of pregnancy. She was
taking both ondansetron and romethezine since diagnosed with
HG, and ginger was added two weeks later, with minimal
effectiveness. Her Motherisk Pregnancy-unique Quantification of
Emesis and Nausea (PUQE) scale was 15 on admission. Her
current hospitalization was due to placenta previa (PPr) causing
vaginal bleeding. A complete blood count showed a slightly
increased white blood cell count and decreased hemoglobin and
hematocrit, likely due to bleeding fro PPr.
Save decreased total protein and albumin, a complete
metabolic panel was within normal limits. Her Hamiliton Anxiety
Scale (HAM-A) 5 score equaled 22 on admission.
We began our patient was on gabapentin 100mg TID,
increased to 300mg TID after two days. After three days of
the increased gabapentin dosage, her Motherisk PUQE and
HAM-A scores were 8 and 6, respectively. 4,5 She was
discharged from the hospital and instructed to continue the
gabapentin 300mg TID. The patient subsequently delivered two
weeks later, at gestational age of 27 weeks, and Apgar score
6 of 8 at five minutes and two pounds, seven ounces. Our
patient’s admission Motherisk PUQE scale score was 5.
Additionally, while the obstetrician thought this premature
delivery was due to obstetrical complication of PPr, gabapentin
administration could not be ruled out.
 Typically includes nausea that doesn’t go away
and severe vomiting that leads to severe dehydration.
This doesn’t allow you to keep any food or fluids
down. HG can be extremely debilitating and cause
fatigue that lasts for weeks or months.
The cause is unknown but women with the disorder
may have increased thyroid function because of
thyroid stimulating properties of human chronic
gonadotropin.
Associated with helicobacter pylori (same bacteria
that cause peptic ulcer)
 Hyperemesis Gravidarum usually starts during the
first trimester of pregnancy. Some of the most common
symptoms of HG are:
 Feeling nearly constant nausea
 Loss of appetite
 Vomiting more than three of four times per day
 Becoming dehydrated
 Feeling light-headed or dizzy
 Losing more than 10 pounds or 5 percent of your
body weight due to nausea and vomiting
 Some factors that could increase your risk of getting
HG are:
 having a history of HG in your family
 Being pregnant with more than one baby
 Being Overweight
 Being a first-time mother
Trophoblastic disease can also cause HG.
Trophoblastic disease occurs when there’s an abnormal
growth of cells inside the uterus.
Always try to determine exactly how much
nausea and vomiting women are having during
pregnancy. Ask the patient to describe the events
of the day before:
 How late into the day did the nausea last?
 How many times did she vomit and how much?
 What was the total amount of food she was
able to eat?
 Women with hyperemesis gravidum may need to be
hospitalized for about 24 hours to document and monitor their
intake, output, and blood chemistries and to restore hydration.
All oral food and fluid are usually withheld for the first 24
hours. Intravenous fluid (e.g., 3,000 ml Ringer’s lactate with
added vitamin B) may be administered to increase hydration.
An antiemetic, such as metoclopramide (Reglan, pregnancy
class B), may be prescribed to control vomiting. Throughout this
period, carefully measure intake and output, including the
amount of vomitus, so the degree of hydration can best be
evaluated.
 If there is no vomiting after first 24 hours of
oral restriction, small amounts of clear fluid can
be started and the woman discharged home,
usually with a referral for home care. If she can
continue to take clear fluid without vomiting, small
quantities of dry toast, crackers, or cereal can be
added every 2 to 3 hours, after which the woman
may be gradually advanced to a soft diet and
then to a regular diet. If vomiting returns at any
point, enteral or total parenteral nutrition may be
prescribed to ensure she receives adequate
nutrition (O’ Donnell et al., 2016)