Case Report: Midwifery Care for Second-Trimester Emesis Gravidarum with Evening-Predominant Symptoms

Abstract

Emesis gravidarum is common in early pregnancy, typically manifesting as morning sickness and subsiding by 12–16 weeks of gestation. However, persistent symptoms, particularly with evening predominance, may present clinical challenges. This case describes an atypical presentation of emesis gravidarum in the second trimester. This descriptive case report was conducted from January 29 to March 8, 2026, at the Independent Midwife Practice of Mrs. E, Bendo District, Magetan Regency, Indonesia. The subject was a second-trimester pregnant woman experiencing evening-predominant emesis gravidarum. Assessment and documentation used the SOAP approach, supported by structured assessment formats. Informed consent was obtained from the participant. At 20 weeks of gestation, the patient experienced nausea and vomiting 4–5 times daily, accompanied by reduced appetite and mild dehydration. Following four midwifery care visits, nausea decreased and occurred occasionally when exposed to strong odors, while vomiting ceased. Appetite was restored, maternal weight increased, vital signs remained stable, no signs of dehydration were observed, and fetal condition remained within normal limits. The case demonstrates an atypical evening-predominant pattern of emesis gravidarum in the second trimester. Hormonal changes, environmental triggers, and maternal fatigue may contribute to symptom patterns. Combined pharmacological and non-pharmacological interventions supported symptom improvement. Individualized and holistic midwifery care with continuous monitoring and tailored interventions can support maternal and fetal well-being in atypical emesis gravidarum.