# Clinical Overview of Hyperemesis Gravidarum for Trainees
> A comprehensive guide to Hyperemesis Gravidarum (HG) covering pathophysiology, diagnosis using the PUQE scale, management protocols, and treatment strategies.

Tags: hyperemesis-gravidarum, obstetrics-and-gynecology, medical-education, pregnancy-care, clinical-guidelines, maternal-health
## Understanding Hyperemesis Gravidarum
* **Definition:** Severe form of nausea and vomiting in pregnancy (NVP) involving >5% weight loss and metabolic disturbances.
* **Epidemiology:** Affects 0.3–3% of pregnancies; recurrence rate is 15–81%.
* **Pathophysiology:** Linked to hCG levels, Estrogen, and Progesterone; multifactorial etiology.

## Diagnosis & Assessment
* **Criteria:** Clinically diagnosed if symptoms start before 10 weeks with significant weight loss and ketonuria.
* **PUQE Scale:** Uses nausea duration, vomiting episodes, and retching to grade severity.
* **Labs:** Checks for ketones, electrolyte imbalance (hypokalemia), and raised transaminases.

## Complications
* **Maternal:** Wernicke's Encephalopathy (B1 deficiency), Mallory-Weiss tears, and PTSD.
* **Fetal:** Risk of IUGR, low birth weight, and preterm birth.

## Treatment Strategies
* **Non-Pharmacological:** Small frequent meals, ginger (250mg QID), and Vitamin B6 (10–25mg TID).
* **Pharmacological:** Stepwise approach using Doxylamine, Metoclopramide, and Ondansetron.
* **IV Therapy:** Normal Saline/Hartmann's. **Crucial:** Give Thiamine BEFORE dextrose to prevent Wernicke's Encephalopathy.

## Outcomes & Support
* **Prognosis:** Most cases resolve by 20 weeks; management involves an MDT approach.
* **Psychosocial:** HG is not psychological in origin; peer support and validation are essential for maternal wellbeing.
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