Comprehensive Midwifery Care in Very High-Risk Pregnancy with Hyperemesis Gravidarum

Abstract

Introduction: Hyperemesis gravidarum (HEG) is a multifactorial condition that may be aggravated by high-risk pregnancy factors such as advanced maternal age, grand multiparity, short interpregnancy interval, and history of cesarean section or intrauterine fetal death (IUFD). Methods: This descriptive case report was conducted from January 27 to February 9, 2026, at Puskesmas P, Parang District, Magetan Regency, Indonesia, involving a 37-year-old grandemultigravida (G5P4A0H3) with a KSPR score of 22. Data collection applied the SOAP approach with observation sheets, PUQE scoring, weight monitoring, and blood pressure measurement. Results: Clinical findings included recurrent nausea and vomiting, reduced nutritional intake, 7.14% weight loss, dehydration, and hemoconcentration, with an initial PUQE score of 12 (moderate). After intravenous rehydration, antiemetic therapy, nutritional counseling, and psychological support, progressive improvement was observed with PUQE scores decreasing to 3, cessation of vomiting, improved intake, and weight gain to 53 kg. Discussion: The case highlights the multifactorial nature of HEG and demonstrates that effective management requires a dynamic approach, shifting from acute treatment of dehydration and nutritional deficits to ongoing surveillance of very high-risk pregnancy, prevention of complications, and preparation for safe delivery. Conclusion: Comprehensive midwifery care integrating medical collaboration, supportive interventions, and continuous monitoring proved effective in resolving HEG and optimizing maternal and fetal outcomes, while antenatal surveillance remained essential due to the persistently high-risk profile.
Keywords: Pregnancy, very high risk, hyperemesis gravidarum.