How can I assess the severity of hyperemesis gravidarum in a patient presenting with nausea and vomiting?

Assessment of severity of hyperemesis gravidarum (HG) in a patient presenting with nausea and vomiting involves clinical evaluation and use of scoring tools.

• Use the Pregnancy-Unique Quantification of Emesis (PUQE) score to quantify severity; a PUQE score greater than 13 indicates severe symptoms and may warrant hospital admission.
• Assess for clinical dehydration signs such as dry mucous membranes, sunken eyes, reduced skin turgor, tachycardia, and decreased urine output.
• Evaluate weight loss; loss of greater than 5% of body weight is a marker of severity.
• Consider the patient’s ability to tolerate oral intake, including antiemetics and fluids; inability to tolerate oral medications or fluids suggests more severe disease.
• Look for complications such as electrolyte imbalances, mental health concerns, or co-morbidities that may increase severity.
• Monitor for prolonged vomiting and failure to respond to primary care or outpatient management.
• In cases of severe or refractory symptoms, inpatient care with intravenous fluids, electrolyte replacement, thiamine supplementation, and possibly enteral or parenteral feeding may be required.

Regular reassessment after 24-72 hours of treatment is recommended to evaluate response and adjust management accordingly.

Women with severe symptoms or late trimester presentation should have serial ultrasound scans to monitor fetal growth.

Referral to or involvement of a multidisciplinary team may be necessary for severe cases.

These assessment criteria are based on NICE guidelines and the Royal College of Obstetricians and Gynaecologists (RCOG) recommendations.

Summary: Use PUQE score, clinical signs of dehydration, weight loss >5%, inability to tolerate oral intake, presence of complications, and response to treatment to assess severity of hyperemesis gravidarum.

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