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Nausea and vomiting during pregnancy affect up to 80% of pregnant women and are one of the most common indications for hospitalization during pregnancy.

Hyperemesis gravidarum (HG) is the severe form of vomiting during pregnancy, affecting from 0.3 to almost 4% of all pregnancies.

Almost 20% of pregnant women hospitalized during their first pregnancy for this diagnosis will need hospital treatment in a subsequent pregnancy. The presence of concomitant conditions such as hyperthyroidism, diabetes, multiple pregnancy, previous molar pregnancy or asthma increases the risk of this complication occurring.

The diagnosis is made only when symptoms appear in the first trimester of pregnancy and no other causes of nausea and vomiting are found. Symptoms usually appear between 4 and 6 weeks of gestation, with a peak around 9-10 weeks, and in about 80-90% of women will resolve completely by 20 weeks. In cases of long-persisting nausea and vomiting, an underlying etiology/pathology must be excluded. In severe cases with repeated vomiting, signs of dehydration and/or electrolyte imbalance, and loss of body weight, the diagnosis of HG is made. The condition is not accompanied by other symptoms: there is no abdominal pain, no changes in bowel movements, no fever, headache or focal neurological signs.

A thorough medical history is important for correctly assessing the condition of the pregnant woman. Accurate assessment of severity and clinical condition is important for adequate treatment and management. An assessment is made of the pregnant woman's general condition: temperature, pulse, blood pressure, signs of dehydration, current weight. Necessary tests: CBC, coagulation, electrolytes, acid-base analysis, liver panel, blood glucose, creatinine, urea, urine. Vomiting during pregnancy and HG are associated with hyponatremia, hypokalemia, increased hematocrit with metabolic hypochloremic alkalosis and ketonuria. In severe cases, metabolic acidosis develops. Abnormal thyroid function may be found in more than half of pregnant women. Elevated transaminases are found in about 40% of patients with HG. Bilirubin levels are mildly elevated, but without signs of jaundice.

Management depends on the severity of symptoms, dehydration and weight loss. It includes dietary measures, lifestyle changes, use of medications, or even hospitalization for the purpose of stabilizing the condition and parenteral rehydration.

It is important to assess to what extent the patient's quality of life has been affected and to attempt to change environmental factors that contribute to symptom worsening, ensure adequate hydration, and reduce consequences for the mother and fetus.

There are several strategies for preventing nausea and vomiting in pregnant women in the first trimester: vitamin complexes containing folates, especially in cases with a history of involvement in previous pregnancies (if possible, intake should begin before the pregnancy starts); frequent meals with small amounts of food (avoiding fatty and spicy foods); avoiding prolonged fasting; taking fluids 30 minutes before or after eating solid food; ginger in the form of tea or as an addition to juices; salads.

Most commonly used medications:

• Dopamine antagonists (Metoclopramide);
• Antihistamines (H1 blockers) (Promethazine, Dimenhydrinate);
• Selective 5HT3 receptor agonist (Ondansetron);
• Glucocorticosteroids - not before 10 weeks of gestation (Methylprednisolone, Hydrocortisone);
• H2 blockers (Ranitidine, Famotidine);
• Infusions: if the patient's condition requires fluid replacement for more than 24 hours and vomiting continues, it is recommended to add vitamin B1 (thiamine) intravenously.

If treatment continues longer, it is appropriate to repeat thiamine administration weekly; Enteral and parenteral nutrition - women refractory to all other pharmacological and non-pharmacological interventions are indicated for enteral or parenteral nutrition, the duration of which depends on their condition.

Pregnant women with severe vomiting who require multiple hospitalizations and fail to regain weight have a higher risk of preterm birth and low birth weight. Suitable for discharge are women who have no more than 1+ ketones in urine, have no abnormalities in laboratory values and/or subjective complaints, and can take food and fluids without vomiting. Upon discharge, pregnant women should be advised to continue antiemetic therapy and adherence to a dietary regimen. They should also be advised to seek help if there is a new occurrence or worsening of nausea and vomiting symptoms with the appearance of signs of dehydration. Earlier resumption of treatment may reduce the need for rehospitalization and lead to faster symptom improvement. It is important for pregnant women to be aware of the safety of the treatment being administered with respect to the fetus.

According to published data, in about 10% of pregnant women with severe hyperemesis, pregnancy termination occurs due to lack of treatment effect. Pregnancy termination should be discussed after exhausting all therapeutic options, including antiemetics, steroids, parenteral nutrition and electrolyte correction. A psychiatric consultation is also appropriate when making the decision to terminate. It is preferable for the decision to be multidisciplinary, with adequately documented lack of effect from the treatment administered.