What are the key diagnostic criteria for hyperemesis gravidarum in pregnant patients?

Key diagnostic criteria for hyperemesis gravidarum in pregnant patients include:

• Severe and persistent nausea and vomiting beyond the first trimester, often continuing into the late second or third trimester.
• Inability to tolerate oral intake, leading to dehydration and electrolyte imbalances.
• Significant weight loss, typically greater than 5% of pre-pregnancy body weight.
• Clinical features of dehydration such as tachycardia, hypotension, or orthostatic changes.
• Need for inpatient care if vomiting is severe, refractory to outpatient management, or if complications arise.
• Use of the PUQE (Pregnancy-Unique Quantification of Emesis) score may assist in assessing severity, with scores less than 13 potentially managed outpatient, and higher scores indicating need for more intensive care.

Women with hyperemesis gravidarum may require multidisciplinary management including fluid and electrolyte replacement, antiemetics (via various routes if oral is not tolerated), thiamine supplementation, and nutritional support.

Serial ultrasound scans may be offered to monitor fetal growth if symptoms persist into later pregnancy.

Admission is recommended if there is inability to take oral medications, evidence of clinical dehydration, significant weight loss, or mental health concerns.

These criteria are based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline and NICE recommendations on nausea and vomiting in pregnancy and hyperemesis gravidarum management.