According to an updated practice bulletin, The American College of Obstetricians and Gynecologists urges clinicians to treat nausea and vomiting of pregnancy as early as possible to prevent it from progressing to hyperemesis gravidarum . The practice bulletin was published in the  Obstetrics & Gynecology

There is no single accepted definition of hyperemesis gravidarum exists. It is a clinical diagnosis of exclusion based on a typical presentation in the absence of other diseases that could explain the findings. The most commonly cited criteria include persistent vomiting related to other causes, a measure of acute starvation, and some discrete measure of weight loss, most often at least 5% of prepregnancy weight. Electrolyte, thyroid, and liver abnormalities also may be present.

Level A recommendations, which are made on the basis of good and consistent scientific evidence, include:

  1. Use Vitamin B 6  alone or in combination with doxylamine as first-line pharmacotherapy, as they are safe and effective.
  2. Clinicians should encourage women to take prenatal vitamins for 1 month before fertilization, as it may decrease    the incidence and severity of nausea and vomiting during pregnancy.
  3. The authors recommended supportive therapy for abnormal maternal thyroid tests caused by gestational transient  thyrotoxicosis or hyperemesis gravidarum, or both, and recommends against antithyroid medications.

Level B recommendations, which are made on the basis of limited or inconsistent scientific evidence, include:

  1. Ginger may be used as a nonpharmacologic option, as it has had some beneficial effects in the treatment of nausea and vomiting of pregnancy.
  2. Methylprednisolone has been effective in some refractory cases of severe nausea and vomiting of pregnancy; However, it should be considered a last-resort treatment as a result of its risk profile.

Level C recommendations, which are made primarily on the basis of consensus and expert opinion, include:

  1. Early treatment of nausea and vomiting of pregnancy may help prevent it from progressing to hyperemesis gravidarum.
  2. Intravenous hydration should be administered to patients who are unable to tolerate oral fluids for a prolonged period and if clinical signs of dehydration develop.
  3.  Strongly considered correction of ketosis and vitamin deficiency. Include dextrose and vitamins in therapy in cases of prolonged vomiting; consider administering thiamine before dextrose infusion to prevent Wernicke encephalopathy.
  4. Begin enteral tube feeding as first-line treatment to support nutrition for women with hyperemesis gravidarum who do not respond to medical therapy and who are unable to maintain their weight.
  5. Use centrally inserted catheters only as a last resort in women with hyperemesis gravidarum, as indicated by the intervention, and there is a potential for severe maternal morbidity.

 After the patient has been hospitalized and a workup for other causes of severe vomiting has been undertaken, intravenous hydration, nutritional support, and modification of antiemetic therapy often can be accomplished at home.

In concussion: However, the option of hospitalization for observation and further assessment should be preserved for patients who experience a change in vital signs or a change in mental status, continue to lose weight, and are refractory to treatment.