Hyperemesis Gravidarum (severe pregnancy sickness)

NVP vs. Hyperemesis Gravidarum

Pregnancy sickness (Nausea and Vomiting of Pregnancy, NVP) is common: up to 80% of pregnant women are affected, and the symptoms usually settle on their own by weeks 12–16 of pregnancy. Hyperemesis Gravidarum needs to be distinguished from this — it is a condition that requires treatment and not a “normal” pregnancy discomfort.

Hyperemesis is the severe form of NVP and a clinical diagnosis of exclusion. The overall clinical picture matters, not a single number:

• Persistent severe nausea and/or vomiting prevents normal eating and drinking.
• Daily activities, work, sleep and quality of life are markedly impaired.
• Dehydration, rapid weight loss and electrolyte disturbances can occur, but may not be present in everyone at the outset.
• Other causes must be excluded — particularly where there is abdominal pain, fever, pain when passing urine, neurological symptoms, or symptoms begin for the first time after 16 weeks.

Severity is assessed using symptom duration and frequency (for example PUQE-24), fluid and food intake, day-to-day function, weight trend, hydration, vital signs and, where needed, laboratory results. Ketonuria can occur when food intake is reduced, but on its own it is neither a necessary diagnostic criterion nor a reliable measure of severity. The absence of ketonuria must not delay necessary treatment.

Hyperemesis is not a failure. The symptoms are taken seriously as a medical condition.

Warning signs — please get in touch straight away

Self-help & nutrition

These measures may ease mild to moderate symptoms. They do not replace medical assessment where symptoms remain severe, fluid intake is restricted or warning signs occur:

• Drinking: sip by sip and regularly — tea, clear soup, diluted juices or electrolyte solutions (e.g. diluted apple juice). Avoid large amounts all at once.
• Meals: 5–8 small portions a day, and try to avoid long gaps on an empty stomach. Cold or room-temperature food is often tolerated better than hot food.
• Plain food: salty snacks (crackers, salted sticks), dry carbohydrates. Avoid strongly scented, fatty or spicy food.
• Ginger: may reduce mild nausea, but a reliable effect on vomiting has not been shown. If you take anticoagulant medication, do not use it without medical advice.
• Rest & reducing stress: distraction after eating can help; stress often makes nausea worse.

Medication

If conservative measures are not enough, early stepwise medication can be used. The choice and combination depend on severity, stage of pregnancy, other conditions and previous treatment and are made by the doctor:

• Pyridoxine (vitamin B6) alone may reduce nausea; it has not been shown to reliably reduce vomiting. Any other vitamin-B6-containing products must be included when considering the total dose.
• Cariban (doxylamine + pyridoxine) is authorised in Switzerland for the symptomatic treatment of NVP in adults when conservative measures have not provided sufficient relief. According to the product information, the combination has not been studied in hyperemesis gravidarum; severe hyperemesis therefore requires a broader medical assessment and treatment plan. Cariban can cause drowsiness — do not drive or operate machinery until medically cleared, avoid alcohol, and use other sedating medicines at the same time only after medical review.
• Other antiemetics or antihistamines may be used alone or in combination according to the clinical course. We discuss benefits, risks, interactions and the appropriate timing individually.
• P6 acupressure or acupuncture is considered low risk, but effectiveness is uncertain and it does not replace medication or intravenous treatment when these are needed.

Please do not start, combine or change medicines or vitamin supplements without medical advice.

Inpatient treatment

If you are dehydrated, have abnormal laboratory results or rapid substantial weight loss, cannot keep fluids or medication down, or symptoms cannot be managed as an outpatient, outpatient intravenous treatment or hospital admission may be needed. Fluids and electrolytes are replaced, laboratory results and urine output are monitored, antiemetics are adjusted, and other causes or complications are assessed.

Sources: Swissmedic product information — Cariban (German) · SGGG — Recommendation No. 88 (German) · RCOG/BJOG — Green-top Guideline No. 69, second edition 2024 · Last updated: July 2026 · These notes do not replace individual medical advice.