Had an interesting case this week. 25 yo G3P2 presented after about 6 weeks amenorrhea with typical sxs of early pregnancy – breast tenderness, nausea and vomiting. She had done a home urine HCG which was positive 3 days earlier.
Tonight she has come in with persistent vomiting, poor oral intake and feeling like crap. Urinalysis showed 4+ ketones and SG = 1.030, no glucose. But – here it the but – on questioning, she never really got any morning sickness with her 2 previous pregnancies. So what is going on? Is this “normal emesis gravidarum” or is there another cause?
I think we sometimes get a bit casual with this scenario – we all know how to manage the early pregnancy chucking, but we still need to consider the possible differentials before going down the well trodden treatment pathways.
Nice review here on the topic. Surprisingly the babies of these poor women do well, there is an increased incidence of small-for-age, low birth weight and premature delivery. The miracle is that the outcomes are not worse given the sometimes severe and prolonged nutritional problems!
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact