Hyperemesis gravidarum
Defining hyperemesis with the Windsor criteria and PUQE-24, GDF15, the investigations that matter, stepwise antiemetics including ondansetron and steroids, fluids with thiamine first, Wernicke encephalopathy and gestational thyrotoxicosis.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Nausea and vomiting of pregnancy (NVP) affects about 70% of pregnant women. Hyperemesis gravidarum (HG) is the severe end, in about 1.1%.
- Onset is between 4 and 10 weeks. Most improve by 20 weeks, but up to 10% with HG have symptoms through pregnancy.
- SOMANZ (updated 2023) now uses the Windsor definition, so 5% weight loss is no longer required.
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Sources
- SOMANZ position statement on the management of nausea and vomiting in pregnancy and hyperemesis gravidarumAU/NZSociety of Obstetric Medicine of Australia and New Zealand (Lowe SA et al.); 2019 version summarised in Aust N Z J Obstet Gynaecol 2020;60:34-43, Updated October 2023 (current; adopts the Windsor definition of HG; no later update found, November 2026)
- The management of nausea and vomiting in pregnancy and hyperemesis gravidarum (Green-top Guideline No. 69)Nelson-Piercy C et al. Royal College of Obstetricians and Gynaecologists, BJOG 2024, 2024 (corrections 2025 and 2026)
- Therapeutic Guidelines: Gastrointestinal (nausea and vomiting in pregnancy)AU/NZTherapeutic Guidelines Limited
- ACOG Practice Bulletin No. 189: Nausea and vomiting of pregnancyAmerican College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e15-30, 2018
- The Windsor definition for hyperemesis gravidarum: a multistakeholder international consensus definitionJansen LAW et al. Eur J Obstet Gynecol Reprod Biol 2021;266:15-22, 2021
- GDF15 linked to maternal risk of nausea and vomiting during pregnancyFejzo M et al. Nature 2024;625:760-7, 2024
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback