Hyperemesis Gravidarum

Description

General measures

Medicine treatment

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O21.0/1/9

DESCRIPTION

Recurrent vomiting leading to ketosis, generally in the first trimester.
Exclude:

• medical causes, e.g., thyrotoxicosis, and
• molar pregnancy.

GENERAL MEASURES

Counselling. 
Frequent small, dry meals.
Avoid fatty and spicy foods.
Restrict oral intake for 24–48 hours, but ensure adequate intravenous hydration.

MEDICINE TREATMENT

Correct electrolyte imbalance with IV fluids.

• Pyridoxine, oral, 25 mg 8 hourly.

AND

• Vitamin B complex, IV, 10 mL.

AND

• Promethazine, oral/IM/IV 25 mg 8 hourly as needed.

LoE:IIIb^xxvii

If no/poor response:

ADD

• Metoclopramide, oral/IV, 10–20 mg 6 hourly as needed.

LoE:IIIb^xxviii

In refractory cases:

Administer daily until hyperemesis is controlled:

• Dexamethasone, IM/IV, 4–8 mg daily.

AND

• Ondansetron, IV, 4–8 mg over 5 minutes, daily.

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​​​​​​​Note:

There is uncertainty regarding the safety of ondansetron in the first trimester. Use with caution and only when necessary.
LoE:IIIb^xxix 

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Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026

Chapter 6 Obstetrics_6.10 Hyperemesis Gravidarum