Current Obstetrics & Gynaecology (2005) 15, 123–131 Hyperemesis, gastrointestinal and liver disorders in pregnancy Alec Welsh à Depertment of Obstetrics, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia Summary This review of the gastrointestinal and hepatic systems in pregnancy concentrates on those conditions that are frequent and troublesome (gastro- oesophageal reflux and constipation), distressing (hyperemesis gravidarum) or potentially fatal [obstetric cholestasis, acute fatty liver of pregnancy and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome]. & 2005 Elsevier Ltd. All rights reserved. Nausea and vomiting, and hyperemesis gravidarum Nausea and vomiting Gestational nausea, with its misnomer ‘morning sickness’, affects 50–90% of the pregnant popula- tion, and gestational vomiting affects about 50%, mostly in the first trimester, with persistence through pregnancy in 20% of cases. Aetiology is multifactorial including physiological, psychologi- cal, genetic and cultural components. More pre- valent in young, white, obese primigravida with less education and who do not smoke, it may be associated with higher levels of human chorionic gonadotrophin (hCG), lower levels of prolactin and higher levels of oestradiol. It may also be asso- ciated with impaired gastric slow-wave function and increased residual volume. Many therapies have been evaluated as well as simple interventions including eating small, fre- quent, bland meals, avoiding fatty foods and increasing rest. Safe treatments include: antihista- mines; the combination drug Bendectin (Debendox) containing doxylamine, vitamin B6 (pyridoxine) and previously dicyclomine; pyridoxine alone; and acupuncture or acupressure at the P6 or Neiguan point on the wrist. The disaster of thalidomide exposure prompted extreme caution with pharma- cological agents in the treatment of a condition as common as nausea and vomiting (NAV), which occurs at the time of fetal organogenesis. ARTICLE IN PRESS www.elsevier.com/locate/curobgyn KEYWORDS Hyperemesis gravi- darum; Gestational nausea and vomiting; Obstetric cholestasis; AFLP; HELLP; Hepatitis 0957-5847/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.curobgyn.2005.01.001 à Tel.: +612 9515 7402; fax: +612 9565 1595. E-mail address: alec.welsh@email.cs.nsw.gov.au.