Vomiting in early pregnancy

1. Big picture

Vomiting in early pregnancy is usually normal nausea and vomiting of pregnancy, but the exam-important severe form is hyperemesis gravidarum.

The examiner wants you to recognize this clinical pathway:

Pregnant woman in 1st trimester + severe vomiting
        ↓
Assess dehydration and weight loss
        ↓
Check urine/blood ketones and electrolytes
        ↓
Exclude dangerous causes: molar pregnancy, multiple pregnancy, ectopic, infection, GI/surgical disease
        ↓
Rehydrate + correct electrolytes + give thiamine + pregnancy-safe antiemetics

The key danger is not the vomiting itself, but the consequences:

Persistent vomiting
        ↓
Dehydration + starvation
        ↓
Ketonuria + electrolyte disturbance
        ↓
Weight loss
        ↓
Wernicke encephalopathy, renal impairment, thrombosis, fetal growth risk

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