Definition of Hyperemesis Gravidarum
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Hyperemesis Gravidarum definition clinical criteria diagnosis
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Hyperemesis Gravidarum (HG)
Hyperemesis Gravidarum is a severe form of nausea and vomiting in pregnancy that goes beyond typical morning sickness. It is defined by the following triad of features:
| Feature | Threshold |
|---|---|
| Persistent vomiting | Intractable, not relieved by conservative measures |
| Weight loss | ≥ 5% of pre-pregnancy body weight |
| Dehydration | With associated ketonuria |
(Reproductive Health and Liver Disease, p. 28)
Key Clinical Points
- Incidence: Affects 0.35% to 2.0% of pregnancies.
- Timing: Typically occurs in the first trimester; symptoms rarely persist throughout the entire pregnancy.
- Liver involvement: Abnormal liver enzymes occur in approximately 50% of cases, though levels rarely exceed 1,000 IU/mL. ALT is generally greater than AST; jaundice is rare.
- Biochemical resolution: Abnormalities typically resolve with hydration and cessation of vomiting.
- Liver biopsy (rarely indicated): When performed, shows normal parenchyma, mild fatty change, or bland cholestasis.
Distinction from Normal Pregnancy Nausea
Nausea and vomiting affect up to 80% of pregnancies (commonly called "morning sickness"), but HG is distinguished by the severity of weight loss (≥5%), metabolic derangement (ketonuria, electrolyte imbalances), and the need for medical intervention such as IV hydration or antiemetic therapy.
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