What are the best treatments for hyperemesis gravidarum (HG)? The HER Foundation is advancing current guidelines by developing a comprehensive treatment algorithm to help clinicians in managing HG. This does not prescribe care but offers insight into what patients and clinicians have found most effective since we began our work in 2000. It takes ACOG guidelines and recommended treatment options and puts them into a practical format.

HER Treatment Algorithm

The algorithm is compatible with The American College of Obstetricians and Gynecologists (ACOG) Guidelines and includes numerous embedded strategies for prevention of complications and optimal patient response. Additional recommendations are given in HER’s Care Planning form in the Assessment Packet. 

Evidence-based recommendations exclusive to the HER Algorithm:

  • HER recognizes the pain sensitivity and atrophy resulting from malnutrition and thus recommends avoiding intramuscular injections. 
  • HER adds gastrointestinal mucosal protection prophylactically.
  • HER specifies bowel regimens for prevention of side-effects of serotonin antagonists.
  • HER works with thiamin experts to determine dosing of B1 and required co-factors for prevention of Wernicke’s encephalopathy and cardiac symptoms.
  • HER recommends avoiding medication combinations leading to QR prolongation.
  • HER provides guidance on initiation and maintenance of nutrition to avoid refeeding syndrome.
  • HER offers detailed recommendations on non-oral medication options.

Unfortunately, minimal funds have been allocated for trials of HG therapies, so there is no clear evidence on exact medication regimens. However, clinical practice with many thousands of patients has resulted in this very practical and effective algorithm.

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