Hyperemesis gravidarum

A severe form of pregnancy nausea and vomiting with more than 5% body weight loss, ketonuria, electrolyte disturbance, and dehydration. Affects 0.3–3% of pregnancies, mostly in T1. ACOG 2018 and SEGO 2022 set doxylamine 10 mg + pyridoxine 10 mg 1–4 times daily as first-line. With inadequate response, add metoclopramide or ondansetron (cautiously in T1 per the 2013 Danish cohort); systemic steroids in severe cases. Persistent vomiting with weight loss needs hospital admission for rehydration.

ICD-10 O211 drug

Also known as: Severe pregnancy nausea and vomiting

Drugs used for this condition

BDoxylamine/pyridoxineFirst line · Combination of H1-antihistamine and vitamin B6Used in hyperemesis gravidarum within stepwise therapy. ACOG 2018 and SEGO 2022 set doxylamine + pyridoxine at maximum dose as first-line. With inadequate effect, add metoclopramide or ondansetron (cautiously in T1); severe cases with dehydration need admission for rehydration and systemic steroids (methylprednisolone).

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit