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current state of HG treatment and research?
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The Current State of Hyperemesis Gravidarum (HG) Treatment and Research
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that can lead to dehydration, weight loss, and significant impacts on quality of life. While there are established treatments, research continues to seek more effective and better-tolerated options. The understanding of HG’s causes and optimal management is still evolving, and high-quality evidence for many treatments remains limited.
What’s Standard in HG Treatment Today?
Tiered Approach, Focused on Symptom Relief and Safety
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First-line treatments often start with lifestyle and dietary changes, such as eating small, frequent meals and avoiding triggers, though evidence for these is limited.
Hyperemesis Gravidarum - StatPearls - NCBI BookshelfHyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...Read full articleSource: ncbi.nlm.nih.govTreatment of Hyperemesis Gravidarum - PMCRecent research now provides additional ... effects. Medicinal methods of prevention and treatment include nutritional supplements and alternative methods, such as hypnosis and acupuncture, as well as pharmacotherapy....The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....
- Pharmacologic therapy is the mainstay for moderate to severe cases. Common medications include:
- Antihistamines (e.g., doxylamine, sometimes combined with vitamin B6/pyridoxine)
- Phenothiazines (e.g., promethazine)
- Metoclopramide
- Ondansetron (often used, but with some ongoing debate about safety in early pregnancy)
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Corticosteroids may be considered in severe, refractory cases.
Hyperemesis Gravidarum - StatPearls - NCBI BookshelfHyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...Read full articleSource: ncbi.nlm.nih.govThe impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....698 Reprinted from Australian Family Physician Vol. 36, No. 9, September 2007Nausea and vomiting are common symptoms in early pregnancy. In most women the condition is mild and self limiting. A small percentage of women experience severe nausea and vomiting. This is known as hyperemesisgravidarum. Outcomes have improved with intravenous rehydration therapy.
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IV fluids are used for dehydration and electrolyte imbalances. In severe cases, nutritional support via tube feeding or intravenous nutrition may be needed.
Hyperemesis Gravidarum - StatPearls - NCBI BookshelfHyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...Read full articleSource: ncbi.nlm.nih.govThe impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....Hyperemesis Gravidarum: Causes, Symptoms & TreatmentHyperemesisgravidarum is the medical term for severe nausea and vomiting during pregnancy. The symptoms can be very uncomfortable. You might vomit more than three times a day, become dehydrated, feel constantly dizzy and lightheaded and lose weight. Fortunately there are treatments available, ...Read full articleSource: Cleveland ClinicSevere vomiting in pregnancy - NHSTreatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle. The charity Pregnancy Sickness Support has information and tips on coping with nausea and vomiting, ...Read full articleSource: nhs.uk
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Psychological support is increasingly recognized as important, as HG is associated with higher rates of anxiety, depression, and trauma symptoms.
Hyperemesis Gravidarum - StatPearls - NCBI BookshelfHyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...Read full articleSource: ncbi.nlm.nih.govThe impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....
What’s New and Emerging in HG Research?
Ongoing Challenges and Areas of Focus
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Limited high-quality evidence: Despite many available treatments, few have robust, high-quality studies supporting their use specifically for HG. Most evidence is extrapolated from studies on milder nausea and vomiting of pregnancy.
The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....Diagnosis and treatment of hyperemesis gravidarum - PMCA 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...The impact and management of hyperemesis gravidarum: Current and future perspectives - PubMedCurrent best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support. There is a lack of high-quality evidence on treatment for HG. Future research should focus on understanding the cause, developing effective ...Read full articleSource: PubMed
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Alternative therapies: Some research has explored ginger, acupuncture, and hypnosis. Ginger may help with mild symptoms but is often not effective for HG and can worsen symptoms for some.
Acupressure and hypnosis have mixed evidence and are not widely adopted.Diagnosis and treatment of hyperemesis gravidarum - PMCA 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment - PMCNausea and vomiting in pregnancy (NVP) affects up to 85% of all women during pregnancy, but for the majority self-management suffices. For the remainder, symptoms are more severe and the most severe form of NVP - hyperemesisgravidarum (HG) - ...Hyperemesis Gravidarum Treatment & Management: Approach Considerations, Medical Care, ConsultationsKoren G, Maltepe C. Preemptive Diclectin therapy for the management of nausea and vomiting of pregnancy and hyperemesis gravidarum (abstract). ClinicalTrials.gov. Available athttps://clinicaltrials.gov/show/NCT00293644.Read full articleSource: MedscapeHyperemesis Gravidarum: Practice Essentials, Background, PathophysiologyIn some refractory severe cases of hyperemesisgravidarum, if maternal survival is threatened, or if hyperemesisgravidarum is causing severe physical and psychological burden, termination of the pregnancy may be considered. [5] See Treatment and Medication for more detail.Read full articleSource: Medscape698 Reprinted from Australian Family Physician Vol. 36, No. 9, September 2007Nausea and vomiting are common symptoms in early pregnancy. In most women the condition is mild and self limiting. A small percentage of women experience severe nausea and vomiting. This is known as hyperemesisgravidarum. Outcomes have improved with intravenous rehydration therapy.
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New biological insights: Recent studies are investigating the role of hormones (like human chorionic gonadotropin, hCG) and genetic factors (such as growth differentiation factor 15, GDF15) in HG. These may eventually lead to more targeted therapies, but clinical applications are not yet available.
Diagnosis and treatment of hyperemesis gravidarum - PMCA 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities - PMCPromethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstetr Gynecol. (2010) 115:975–81. 10.1097/AOG.0b013e3181d99290 [DOI] [PubMed] [Google Scholar] 145.Babaei AH, Foghaha MH. A randomized comparison of vitamin B6 and dimenhydrinate in the ...
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Nutritional management: Research is ongoing into the best ways to prevent and treat malnutrition in HG, including the timing and type of nutritional support.
The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....Assessment of management approaches for hyperemesis gravidarum and nausea and vomiting of pregnancy: a retrospective questionnaire analysis | BMC Pregnancy and Childbirth | Full TextIn fact, much of the available research on these medications are based on their use as monotherapies, making treatment with combination therapies based solely on physician experience and preference [15, 18]. Our objective is to identify the subjective efficacy of the various management approaches that are currently in place for nausea and vomiting of pregnancy and hyperemesisgravidarum...Read full articleSource: BioMed Central
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Patient-centered outcomes: There is growing recognition of the need for research that focuses on quality of life, mental health, and patient-reported outcomes, not just physical symptoms.
The impact and management of hyperemesis gravidarum: Current and future perspectives - PubMedCurrent best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support. There is a lack of high-quality evidence on treatment for HG. Future research should focus on understanding the cause, developing effective ...Read full articleSource: PubMedThe far-reaching burden of Hyperemesis Gravidarum - an exploration of women's experiences and perceptions of healthcare support - PubMedFurther research is warranted to determine whether these recommendations would result in improved pregnancy outcomes. Keywords: HyperemesisGravidarum; patient reported outcome; pregnancy; women’s health. ... Women's perspectives on the management and consequences of hyperemesisgravidarum ...Read full articleSource: PubMed
Gaps and Limitations in Current Knowledge
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No cure: There is currently no cure for HG, and treatments are aimed at reducing symptoms and preventing complications rather than addressing the underlying cause.
The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....Diagnosis and treatment of hyperemesis gravidarum - PMCA 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...
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Variable effectiveness: Many people with HG try multiple medications and therapies, often with limited relief and significant side effects.
Assessment of management approaches for hyperemesis gravidarum and nausea and vomiting of pregnancy: a retrospective questionnaire analysis | BMC Pregnancy and Childbirth | Full TextIn fact, much of the available research on these medications are based on their use as monotherapies, making treatment with combination therapies based solely on physician experience and preference [15, 18]. Our objective is to identify the subjective efficacy of the various management approaches that are currently in place for nausea and vomiting of pregnancy and hyperemesisgravidarum...Read full articleSource: BioMed Central
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Long-term effects: Some evidence suggests HG may have modest long-term effects on offspring, but more research is needed to clarify these risks.
Hyperemesis Gravidarum - StatPearls - NCBI BookshelfHyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...Read full articleSource: ncbi.nlm.nih.govDiagnosis and treatment of hyperemesis gravidarum - PMCA 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...
What’s on the Horizon?
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Better understanding of causes: Ongoing research into genetic, hormonal, and environmental factors may lead to more effective and individualized treatments.
Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities - PMCPromethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstetr Gynecol. (2010) 115:975–81. 10.1097/AOG.0b013e3181d99290 [DOI] [PubMed] [Google Scholar] 145.Babaei AH, Foghaha MH. A randomized comparison of vitamin B6 and dimenhydrinate in the ...
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Improved therapies: There is a strong need for new medications and supportive therapies that are both effective and well-tolerated, as well as for better integration of psychological care.
The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online LibraryHyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....The impact and management of hyperemesis gravidarum: Current and future perspectives - PubMedCurrent best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support. There is a lack of high-quality evidence on treatment for HG. Future research should focus on understanding the cause, developing effective ...Read full articleSource: PubMed
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Guideline development: Professional organizations are updating guidelines as new evidence emerges, but recommendations may still vary by region and provider.
The Management of Nausea and Vomiting of Pregnancy and Hyperemesis GravidarumAm J Obstet Gynecol 1998; ... Leveno KJ. A randomized, placebo-controlled trial of · corticosteroids for hyperemesis due to pregnancy. Obstet · Gynecol 2003;102:1250–4. ... Bondok RS, El Sharnouby NM, Eid HE, Abd Elmaksoud AM. Pulsed steroid therapy is an effective treatment forThe Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green‐top Guideline No. 69) - Nelson‐Piercy - 2024 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online LibraryThere is variation in the care ... (NVP) or hyperemesisgravidarum (HG) with the potential for lack of understanding of its severity and options for treatment and support. The aim of this guideline is to provide updated evidence-based or best clinical practice information regarding the diagnosis and subsequent management of NVP and ...
Taking Action: What This Means for You
If you are experiencing HG, current best practice is a stepwise approach that may include medications, IV fluids, nutritional support, and mental health care. Because HG can be complex and severe, working closely with your OB/GYN or maternal-fetal medicine specialist is important for personalized management. Research is ongoing, and new options may become available in the future.
Moving Forward: The Importance of Advocacy and Research
HG is increasingly recognized as a serious condition deserving of more research, better treatments, and greater support for those affected. Advocacy groups and patient-centered research are helping to drive progress in this area.
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Peer-Reviewed Research
Published, peer-reviewed scientific studies from journals or databases.
1
Hyperemesis Gravidarum - StatPearls - NCBI Bookshelf
Hyperemesisgravidarum management strategies depend on the severity of symptoms, hydration levels, and the patient's ability to tolerate food or fluids orally. Treatment guided by ACOG nausea and vomiting in pregnancy guidelines is recommended, in which management approaches progress in a tiered ...
Read full article
Source:
ncbi.nlm.nih.gov
2
Treatment of Hyperemesis Gravidarum - PMC
Recent research now provides additional ... effects. Medicinal methods of prevention and treatment include nutritional supplements and alternative methods, such as hypnosis and acupuncture, as well as pharmacotherapy....
3
The impact and management of hyperemesis gravidarum: Current and future perspectives - Minnen - 2025 - International Journal of Gynecology & Obstetrics - Wiley Online Library
Hyperemesis gravidarum (HG) is ... their offspring. Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support....
7
Diagnosis and treatment of hyperemesis gravidarum - PMC
A 2015 systematic review showed ... in pregnancy.16 · Definitions for hyperemesisgravidarum in clinical and research settings have had a high degree of heterogeneity and historically relied on the presence of ketonuria such as the Fairweather criteria, published in 1968 (Box 2).17,18 However, current evidence does ...
8
The impact and management of hyperemesis gravidarum: Current and future perspectives - PubMed
Current best-practice management includes symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support. There is a lack of high-quality evidence on treatment for HG. Future research should focus on understanding the cause, developing effective ...
Read full article
Source:
PubMed
9
Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment - PMC
Nausea and vomiting in pregnancy (NVP) affects up to 85% of all women during pregnancy, but for the majority self-management suffices. For the remainder, symptoms are more severe and the most severe form of NVP - hyperemesisgravidarum (HG) - ...
12
Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities - PMC
Promethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstetr Gynecol. (2010) 115:975–81. 10.1097/AOG.0b013e3181d99290 [DOI] [PubMed] [Google Scholar] 145.Babaei AH, Foghaha MH. A randomized comparison of vitamin B6 and dimenhydrinate in the ...
13
Assessment of management approaches for hyperemesis gravidarum and nausea and vomiting of pregnancy: a retrospective questionnaire analysis | BMC Pregnancy and Childbirth | Full Text
In fact, much of the available research on these medications are based on their use as monotherapies, making treatment with combination therapies based solely on physician experience and preference [15, 18]. Our objective is to identify the subjective efficacy of the various management approaches that are currently in place for nausea and vomiting of pregnancy and hyperemesisgravidarum...
Read full article
Source:
BioMed Central
The management of nausea and vomiting of pregnancy and hyperemesis gravidarum- A 2013 update | Request PDF
Request PDF | The management of nausea and vomiting of pregnancy and hyperemesisgravidarum- A 2013 update | Nausea and vomiting of pregnancy (NVP) affects up to 85% of all pregnancies, yet many physicians are uncertain as to how to best treat their... | Find, read and cite all the research ...
Read full article
Source:
ResearchGate
The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green‐top Guideline No. 69) - Nelson‐Piercy - 2024 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library
There is variation in the care ... (NVP) or hyperemesisgravidarum (HG) with the potential for lack of understanding of its severity and options for treatment and support. The aim of this guideline is to provide updated evidence-based or best clinical practice information regarding the diagnosis and subsequent management of NVP and ...
Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum - PubMed
Multiple pre-existing conditions and poor maternal and infant outcomes were associated with prolonged HG. The most significant condition prior to pregnancy was allergies suggesting a possible autoimmune component affecting duration of HG. In addition, the most significant lifestyle choice linked ...
Read full article
Source:
PubMed
Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities - PubMed
Review article: Management of hyperemesisgravidarum and nausea and vomiting in pregnancy. Lowe SA, Steinweg KE. Lowe SA, et al. Emerg Med Australas. 2022 Feb;34(1):9-15. doi: 10.1111/1742-6723.13909. Epub 2021 Dec 6. Emerg Med Australas.
Read full article
Source:
PubMed
Hyperemesis Gravidarum: A Holistic Review and Approach to Etiopathogenesis, Clinical Diagnostic and Management Therapy
Several risk factors associated ... Recent research suggests that gemili with both female fetuses may further aggravate the degree of HG. There is a difference saying between journals as journal from Egypt writes that 94.6% of HG occurs in the first trimester (6–12 weeks), although in international journals it is said that HG in nulliparas mother happens more in their first trimester, whereas in multipara in the second trimester.14,32 · Hyperemesisgravidarum tends to happen ...
Read full article
Source:
jsafog.com
The far-reaching burden of Hyperemesis Gravidarum - an exploration of women's experiences and perceptions of healthcare support - PubMed
Further research is warranted to determine whether these recommendations would result in improved pregnancy outcomes. Keywords: HyperemesisGravidarum; patient reported outcome; pregnancy; women’s health. ... Women's perspectives on the management and consequences of hyperemesisgravidarum ...
Read full article
Source:
PubMed
Clinical Guidelines & Professional Sources
Clinical recommendations from government, public health organizations, or professional medical provider associations.
4
698 Reprinted from Australian Family Physician Vol. 36, No. 9, September 2007
Nausea and vomiting are common symptoms in early pregnancy. In most women the condition is mild and self limiting. A small percentage of women experience severe nausea and vomiting. This is known as hyperemesisgravidarum. Outcomes have improved with intravenous rehydration therapy.
6
Severe vomiting in pregnancy - NHS
Treatment can include intravenous fluids, which are given directly into a vein through a drip. If you have severe vomiting, the anti-sickness drugs may also need to be given into a vein or a muscle. The charity Pregnancy Sickness Support has information and tips on coping with nausea and vomiting, ...
Read full article
Source:
nhs.uk
10
Hyperemesis Gravidarum Treatment & Management: Approach Considerations, Medical Care, Consultations
Koren G, Maltepe C. Preemptive Diclectin therapy for the management of nausea and vomiting of pregnancy and hyperemesis gravidarum (abstract). ClinicalTrials.gov. Available athttps://clinicaltrials.gov/show/NCT00293644.
Read full article
Source:
Medscape
11
Hyperemesis Gravidarum: Practice Essentials, Background, Pathophysiology
In some refractory severe cases of hyperemesisgravidarum, if maternal survival is threatened, or if hyperemesisgravidarum is causing severe physical and psychological burden, termination of the pregnancy may be considered. [5] See Treatment and Medication for more detail.
Read full article
Source:
Medscape
14
The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum
Am J Obstet Gynecol 1998; ... Leveno KJ. A randomized, placebo-controlled trial of · corticosteroids for hyperemesis due to pregnancy. Obstet · Gynecol 2003;102:1250–4. ... Bondok RS, El Sharnouby NM, Eid HE, Abd Elmaksoud AM. Pulsed steroid therapy is an effective treatment for
Medical & Academic Institutions
Information from hospitals, research institutions, or academic medical centers known for clinical expertise and research contributions.
5
Hyperemesis Gravidarum: Causes, Symptoms & Treatment
Hyperemesisgravidarum is the medical term for severe nausea and vomiting during pregnancy. The symptoms can be very uncomfortable. You might vomit more than three times a day, become dehydrated, feel constantly dizzy and lightheaded and lose weight. Fortunately there are treatments available, ...
Read full article
Source:
Cleveland Clinic
General Health & Web Sources
Publicly available health-related articles from non-peer-reviewed sources. These may reference research or clinical guidelines, but are not primary sources.
Uncategorized Sources
Information from sources that have not yet been categorized.