Hyperemesis gravidarum is defined as vomiting in early pregnancy sufficient to warrant hospital admission. Vomiting is clearly very common in early pregnancy, but some women suffer disproportionately from it. This can occasionally result in serious sequelae including severe dehydration and increased risk of thromboembolism. Pregnancy outcome is generally unaffected, though there may be an increased incidence of intrauterine growth restriction (IUGR) where sustained vomiting results in maternal weight loss. Treatment options include small light snacks, intravenous rehydration and sometimes antiemetic treatment. Promethazine and metoclopramide are commonly used for this indication. There is uncertainty regarding the effectiveness of anitemetics , and they are generally best avoided unless hydration is compromised. It is important that B vitamins are replenished as Wernicke's encephalopathy can occur. Corticosteroids may have a role in exceptional cases. Ondansetron may also have a role in exceptional cases, but clear evidence of safety in the first trimester is still awaited. Total parenteral nutrition may be required, but this is very rare. It is difficult to predict recurrence risks in a subsequent pregnancy, but some women undoubtedly experience severe nausea and vomiting with every pregnancy.
It is very important that hyperemesis is regarded as a diagnosis of exclusion. Serious underlying causes for ongoing vomiting must be sought such as CNS pathology, gastrointestinal disease or surgical problems. Peptic ulceration is rare in pregnancy but can arise. It is sometimes appropriate to consider endoscopy for women with persistent vomiting or a trial of treatment. Gastro-oesophageal reflux is a much more common problem. The diagnosis is not usually in doubt and the condition can be treated with antacids, sometimes metoclopromide, H2 antagonists and proton pump inhibitors.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.