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Copyright (c) 2025 Sukinah Saeed Taki AL Talaq, Mona Mohammed Basirah
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Hyperemesis Gravidarum: Clinical Management and Nursing Care in Obstetric Practice-An Updated Review
Corresponding Author(s) : Sukinah Saeed Taki AL Talaq
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, marked by persistent vomiting, dehydration, weight loss exceeding 5% of prepregnancy weight, and significant metabolic disturbances. Unlike typical nausea and vomiting of pregnancy, HG follows a pathological course, often requiring hospitalization and posing risks of nutritional deficiencies, electrolyte imbalance, and complications such as Wernicke encephalopathy.
Aim: This review aims to provide an updated, comprehensive overview of the etiology, clinical features, evaluation, and management of hyperemesis gravidarum, with emphasis on evidence-based medical and nursing practices.
Methods: A narrative synthesis of current literature, clinical guidelines, and recent research was used to examine key aspects of HG, including hormonal, genetic, physiological, and psychosocial determinants, as well as clinical assessment tools, treatment strategies, and multidisciplinary care considerations.
Results: Evidence indicates that HG is multifactorial, involving hormonal changes, genetic susceptibility, gastrointestinal adaptations, and neuroendocrine mechanisms. Diagnosis remains clinical and requires exclusion of other conditions. Effective management relies on a stepwise approach, starting with dietary and lifestyle modifications, progressing to antiemetic therapy, and escalating to enteral or parenteral nutrition when necessary. Psychological effects are significant, with increased rates of anxiety, depression, and reduced quality of life. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score provides objective assessment of severity.
Conclusion: Early recognition, structured treatment, and coordinated interdisciplinary care improve maternal recovery and fetal outcomes. Comprehensive management—including medical therapy, nutritional support, and psychological care—is essential for reducing complications and improving quality of life.
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- Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 01;143(6):745-758.
- Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018 Jan;131(1):e15-e30.
- Elkins JR, Oxentenko AS, Nguyen LAB. Hyperemesis Gravidarum and Nutritional Support. Am J Gastroenterol. 2022 Oct 01;117(10S):2-9.
- Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Nausea and vomiting of pregnancy: what about quality of life? BJOG. 2008 Nov;115(12):1484-93.
- Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, Fan Y, Jiang E. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med (Lausanne). 2021;8:809270.
- Geeganage G, Iturrino J, Shainker SA, Ballou S, Rangan V, Nee J. Emergency department burden of hyperemesis gravidarum in the United States from 2006 to 2014. AJOG Glob Rep. 2023 Feb;3(1):100166.
- Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993 Jun;43(371):245-8.
- Di Iorio R, Bianchi P, Casolati E, Piccolo E, Mangrella M. Assessing the approaches to nausea and vomiting in pregnancy: insights from a nationwide survey of Italian gynecologists (PURITY light). Front Med (Lausanne). 2025;12:1462860.
- Nijsten K, van der Minnen L, Wiegers HMG, Koot MH, Middeldorp S, Roseboom TJ, Grooten IJ, Painter RC. Hyperemesis gravidarum and vitamin K deficiency: a systematic review. Br J Nutr. 2022 Jul 14;128(1):30-42.
- Lowe SA, Steinweg KE. Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy. Emerg Med Australas. 2022 Feb;34(1):9-15.
- Vinnars MT, Forslund M, Claesson IM, Hedman A, Peira N, Olofsson H, Wernersson E, Ulfsdottir H. Treatments for hyperemesis gravidarum: A systematic review. Acta Obstet Gynecol Scand. 2024 Jan;103(1):13-29.
- Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J. 2014 Mar 19;13:20.
- Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001 Sep;46(9):835-9.
- Challacombe FL, Bickers E, Gilderthorp R, Buabeng R, Hallett C. Understanding the support needs of women with hyperemesis gravidarum. Midwifery. 2025 Aug;147:104438.
- Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008 Jan;198(1):71.e1-7.
- Nijsten K, Jansen LAW, Limpens J, Finken MJJ, Koot MH, Grooten IJ, Roseboom TJ, Painter RC. Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022 Sep;227(3):414-429.e17.
References
Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 01;143(6):745-758.
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018 Jan;131(1):e15-e30.
Elkins JR, Oxentenko AS, Nguyen LAB. Hyperemesis Gravidarum and Nutritional Support. Am J Gastroenterol. 2022 Oct 01;117(10S):2-9.
Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Nausea and vomiting of pregnancy: what about quality of life? BJOG. 2008 Nov;115(12):1484-93.
Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, Fan Y, Jiang E. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med (Lausanne). 2021;8:809270.
Geeganage G, Iturrino J, Shainker SA, Ballou S, Rangan V, Nee J. Emergency department burden of hyperemesis gravidarum in the United States from 2006 to 2014. AJOG Glob Rep. 2023 Feb;3(1):100166.
Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993 Jun;43(371):245-8.
Di Iorio R, Bianchi P, Casolati E, Piccolo E, Mangrella M. Assessing the approaches to nausea and vomiting in pregnancy: insights from a nationwide survey of Italian gynecologists (PURITY light). Front Med (Lausanne). 2025;12:1462860.
Nijsten K, van der Minnen L, Wiegers HMG, Koot MH, Middeldorp S, Roseboom TJ, Grooten IJ, Painter RC. Hyperemesis gravidarum and vitamin K deficiency: a systematic review. Br J Nutr. 2022 Jul 14;128(1):30-42.
Lowe SA, Steinweg KE. Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy. Emerg Med Australas. 2022 Feb;34(1):9-15.
Vinnars MT, Forslund M, Claesson IM, Hedman A, Peira N, Olofsson H, Wernersson E, Ulfsdottir H. Treatments for hyperemesis gravidarum: A systematic review. Acta Obstet Gynecol Scand. 2024 Jan;103(1):13-29.
Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J. 2014 Mar 19;13:20.
Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001 Sep;46(9):835-9.
Challacombe FL, Bickers E, Gilderthorp R, Buabeng R, Hallett C. Understanding the support needs of women with hyperemesis gravidarum. Midwifery. 2025 Aug;147:104438.
Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008 Jan;198(1):71.e1-7.
Nijsten K, Jansen LAW, Limpens J, Finken MJJ, Koot MH, Grooten IJ, Roseboom TJ, Painter RC. Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gynecol. 2022 Sep;227(3):414-429.e17.