# Hyperemesis Gravidarum: Diagnosis and Management Guide
> A clinical overview of Hyperemesis Gravidarum (HG) covering pathophysiology, GDF15 research, PUQE scoring, and stepwise treatment for medical professionals.

Tags: hyperemesis-gravidarum, obgyn-lecture, pregnancy-complications, medical-education, pathophysiology, maternal-health, clinical-guidelines, gdf15
## Slide 1: Hyperemesis Gravidarum Overview
- Clinical overview for medical students and residents.
- Prevalence: 0.3–3% of pregnancies.
- Leading cause of early hospitalization.

## Slide 2: Definition and Onset
- Characterized by severe nausea, ≥5% weight loss, dehydration, and electrolyte imbalances.
- Onset: 4–6 weeks gestation; Peak: 8–12 weeks.
- PUQE score used for severity quantification.

## Slide 3: Epidemiology & Risk Factors
- #2 cause of early pregnancy hospitalization.
- 24% recurrence rate; 3x risk with family history.
- Annual US cost burden exceeds $3 billion.
- Risk factors include multiple gestation, molar pregnancy, and GDF15 genetic variants.

## Slide 4: Pathophysiology
- Primary Driver: Fetal-placental GDF15 acting on brainstem GFRAL receptors.
- Hormonal Factors: hCG surge, estrogen, and reduced GI motility due to progesterone.
- Genetic Variants: GDF15, PGR, and IGFBP7 genes.

## Slide 5: Clinical Features & Diagnosis
- Symptoms: Nausea >3x/day, ketonuria (≥2+), ptyalism.
- Lab Findings: Hyponatremia, hypokalemia, elevated LFTs (up to 3x normal).
- PUQE Scoring: Mild (≤6), Moderate (7–12), Severe (≥13).

## Slide 6: Complications
- Maternal: Wernicke's Encephalopathy (B1 deficiency), Mallory-Weiss tears, PTSD (83% of patients).
- Fetal: Reduced birth weight, 1.5x increased risk of ADHD/Autism spectrum disorder.

## Slide 7: Stepwise Management Approach
- Step 1: Lifestyle, Ginger, P6 acupressure.
- Step 2: Pyridoxine (B6) + Doxylamine.
- Step 3: IV Hydration, Thiamine (before glucose), Ondansetron, Metoclopramide.
- Step 4: Corticosteroids, Mirtazapine, Enteral/Parenteral nutrition.

## Slide 8: Antiemetic Drug Summary
- Pyridoxine/Doxylamine: FDA Cat A (Safe).
- Ondansetron: Use >10 weeks; monitor QTc.
- Methylprednisolone: Avoid <10 weeks due to cleft palate risk.
- Thiamine: Mandatory before dextrose to prevent Wernicke's.

## Slide 9: Nutritional Support
- Indications for Hospitalization: Inability to tolerate oral intake, >5% weight loss, orthostatic hypotension.
- Escalation Ladder: Oral refeeding → Enteral (NG/NJ tube) → TPN (last resort).

## Slide 10: Psychosocial Impact
- 83% of patients report significant impact; up to 50% experience depression/anxiety.
- Importance of validating patient experience and referring to perinatal mental health services.

## Slide 11: Emerging Research (2024–2026)
- GDF15 confirmed as primary causal driver.
- Pipeline: NGM120 (GDF15 blocker) Phase 2 trials results expected 2026.
- Potential pre-pregnancy metformin pre-conditioning.

## Slide 12: Key Takeaways
- HG is a serious medical condition, not just 'morning sickness'.
- Early clinical diagnosis and stepwise intervention save lives.
- Always administer Thiamine before IV glucose.
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