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Last reviewed: 22 Apr 2025
Last updated: 01 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • first trimester of pregnancy
  • weight loss of >5%

Other diagnostic factors

  • absence of thyroid enlargement/nodules
  • dry mucous membranes
  • postural dizziness
  • tachycardia
  • hypotension
  • ketotic breath

Risk factors

  • family history of hyperemesis gravidarum
  • previous history of NVP
  • multiple gestation or increased placental mass
  • gestational trophoblastic disease
  • other causes of increased placental mass
  • female fetus
  • history of motion sickness
  • history of migraine headache

Diagnostic tests

Tests to consider

  • CBC
  • basic metabolic panel
  • serum LFTs
  • serum BUN and creatinine
  • serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
  • urinalysis
  • urine or serum ketones
  • fetal ultrasound with nuchal translucency
  • serum analytes
  • Helicobacter pylori breath test
  • urine culture
  • serum amylase and lipase
  • abdominal ultrasound
  • renal ultrasound
  • cranial CT or MRI

Treatment algorithm

Contributors

Authors

Jeffrey D. Quinlan, MD, FAAFP

Professor and Chair

Family Medicine

Carver College of Medicine

University of Iowa

Iowa City

IA

Disclosures

JDQ declares that he has no competing interests.

Peer reviewers

Sarah Jorgensen, DO

Faculty Physician

Family Medicine Residency

Naval Hospital Jacksonville

FL

Disclosures

SJ declares that she has no competing interests.

Yosra Tahir Jarjees, MD

Assistant Professor

Head of Department of Obstetrics and Gynecology

Mosul College of Medicine

Mosul

Iraq

Disclosures

YTJ declares that he has no competing interests.

D. Ashley Hill, MD

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital

Orlando

FL

Disclosures

DAH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol. 1998 Sep;41(3):597-605. Abstract

American College of Obstetricians and Gynecologists. Practice bulletin no. 189: nausea and vomiting of pregnancy. Jan 2018 [internet publication].Full text

Matthews A, Haas DM, O'Mathúna DP, et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2015;(9):CD007575.Full text  Abstract

Royal College of Obstetricians and Gynaecologists. Green-top guideline no. 69: the management of nausea and vomiting in pregnancy and hyperemesis gravidarum. Feb 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available here.

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