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

Abstract

Hyperemesis gravidarum (HG) is a multifactorial condition that may be complicated by high-risk pregnancy characteristics. 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 were collected using the SOAP approach, direct observation, serial PUQE assessment, weight monitoring, and blood pressure measurement. The patient presented with recurrent nausea and vomiting, reduced oral intake, 7.14% weight loss, dehydration, and a moderate initial PUQE score of 12. Management included intravenous rehydration, antiemetic therapy, nutritional counseling, supportive counseling, and serial monitoring. PUQE scores decreased to 11 on January 29, 6 on February 3, and 3 on February 9, with cessation of vomiting, improved oral intake, and weight recovery to 53 kg. Discussion: The case demonstrates the need for a dynamic management strategy that progresses from acute stabilization of dehydration and nutritional compromise to continued surveillance of the underlying very high-risk pregnancy. Comprehensive midwifery care integrating medical collaboration, nutritional and supportive interventions, serial symptom assessment, and antenatal surveillance was associated with clinical resolution of HG and recovery of maternal intake and weight.