Management of hyperemesis gravidarum.

Nausea and vomiting in pregnancy are common complaints and vary considerably in duration and severity. Hyperemesis gravidarum represents the extreme end of the spectrum associated with dehydration and weight loss. As embryonic organogenesis occurs during the first trimester, pharmacological intervention for any condition during this period poses a significant clinical dilemma requiring careful assessment of risks and benefits. In the UK, there are no formal national guidelines for the management of hyperemesis gravidarum. In addition, no high-quality evidence exists for i.v. fluid and electrolyte replacement in hyperemesis gravidarum, and a Cochrane review on interventions for the treatment of nausea and vomiting in pregnancy specifically excluded studies on hyperemesis gravidarum. In this article, we review the evidence for the efficacy and safety of different management options for hyperemesis gravidarum.