Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2013, 120, 138
Author: Chong D.M.; Mohammed O.; Mwenechanya S.
Abstract: Introduction Nausea and vomiting is common in pregnancy, affecting about 70% of gravid women up to 20 weeks of gestation. For a minority of the pregnant population, however, the symptoms may be severe and recurrent to cause implications in hydration and nutritional intake where hospital admissions are required. Most admissions are treated with supportive measures and anti-emetics with good reported symptomatic relief. In cases with recurrent admissions and refractory symptoms, further investigations are
required to exclude further organic diseases. We present a case of refractory hyperemesis gravidarum secondary to maternal hydrocephalus. Case A 31-year-old multiparous woman with a singleton pregnancy presented at 10 weeks of gestation with severe vomiting treated as hyperemesis gravidarum. She had two previous uneventful pregnancy and delivery with no significant medical history. Her symptoms were refractory to first line hospital treatments. In addition, the patient reported headaches and diplopia. Further
CT imaging revealed hydrocephalus secondary to aqueduct stenosis. At 11 weeks of gestation, she was transferred to a tertiary neurology specialist centre for endoscopic third ventriculostomy. Despite this, her symptoms worsened post procedure. At 13 weeks of gestation, a right ventriculoperitoneal shunt was inserted. The patient was managed jointly under the obstetricians and neurosurgeons as an outpatient with a plan for elective caesarean section at 39 weeks. However, she presented at 32 weeks of gestation with
confirmed premature prelabour rupture of membranes. With steroids cover, an emergency caesarean section was performed under general anaesthesia with no complications. Conclusion Although hyperemesis gravidarum is not uncommon, recurrent and refractory cases should prompt clinicians to consider other organic causes of vomiting in pregnancy. This is imperative especially in cases with reported associated red flag symptoms. Closer surveillance is recommended in these 'high risk' groups and further detailed research is
required within this field.
