Case 7 - A 40-Year-Old with Nausea, Vomiting, and Weight Loss at 7 Weeks

Summary

Hyperemesis gravidarum is considered the severe end of the spectrum of nausea and vomiting of pregnancy. While there is no agreed upon strict definition for this condition, the criteria include persistent vomiting not related to other causes, a measure of acute starvation, and documented weight loss, most often at least 5% of pre-pregnancy weight. Electrolyte, thyroid, and liver abnormalities also may be present. The incidence of hyperemesis gravidarum is approximately 0.3–3% of pregnancies, but the reported incidence varies because of different diagnostic criteria and ethnic variation in study populations. Risk factors include patients with increased placental mass (molar gestation or multiple gestation), a history of motion sickness, migraine headaches, a family history, and a history of hyperemesis gravidarum in a previous pregnancy. Daughters and sisters of patients who had hyperemesis gravidarum are more likely to have the same condition, as are patients carrying a female fetus. The workup involves ruling out other causes, and the treatment focuses on relieving symptoms and preventing serious morbidity. Hyperemesis gravidarum can significantly impact the quality of life of patients and their families and may be challenging to treat.