ABSTRACT

Hyperemesis gravidarum affects 2.5% of pregnant woman and is characterized by persistent vomiting, weight loss of more than 5%, dehydration, ketonuria, and electrolyte abnormalities. Currently, there is no consensus on its definition, and there is no single, widely used set of criteria for diagnosing hyperemesis gravidarum. The aim of this study was to determine the accuracy of point-of-care ketone blood tests in diagnosing hyperemesis gravidarum.

Patients with a gestational age of <16 weeks were included and both capillary blood ketone and urine ketone levels were determined and analyzed. The diagnosis of hyperemesis gravidarum was based on two criteria: (1) persistent nausea and vomiting requiring hospitalization in the emergency department (ED) and (2) weight loss of more than 5% with nausea and vomiting.

A total of 177 pregnant women with nausea and vomiting were admitted to the ED during the study period. Patients with lost files (n=73) and unsuitable gestational age (n=2) were excluded from the study. Mean gestational age was 63.1±2 days. Overall, 68.6% of the patients had emesis and 31.4% were diagnosed with hyperemesis gravidarum. The diagnostic accuracy of the point-of-care capillary blood ketone median level and urine ketone median level in emesis and hyperemesis gravidarum was 0.1, 95% CI (0.03–0.20), 0.7, 95% CI: 0.30–1.00, p<0.0001, and 0, 95% CI: 0.00–0.00, 2, 95% CI: 1.00–3.00, p<0.0001, respectively.

A rapid, bedside capillary blood ketone measurement can reliably help to diagnose hyperemesis gravidarum in patients with pregnancy-induced nausea and vomiting.

Keywords: Ketone body, hyperemesis gravidarum, emergency