Managing hyperemesis gravidarum: a multimodal challenge

Up to 90% of pregnant women experience nausea and vomiting. When
prolonged or severe, this is known as hyperemesis gravidarum (HG),
which can, in individual cases, be life threatening. In this
article the aetiology, diagnosis and treatment strategies will be
presented based on a selective literature review. Treatment
strategies range from outpatient dietary advice and antiemetic
drugs to hospitalization and intravenous (IV) fluid replacement in
persistent or severe cases. Alternative methods, such as
acupuncture, are not yet evidence based but sometimes have a
therapeutic effect. In most cases, the condition is self limiting
and subsides by around 20 weeks gestation. More severe forms
require medical intervention once other organic causes of nausea
and vomiting have been excluded. In addition, a psychosomatic
approach is often helpful. In view of its potential complexity,
general practitioners and obstetricians should be well informed
about HG and therapy should be multimodal.