103. Hypermesis Gravidarum

Question 1

What is hyperemesis gravidarum?

Answer 1

Excessive or persistent vomiting in pregnant woman that leads to ketosis or 5% weight loss

Question 2

What may hyperemesis gravidarum lead to in the mother and fetus

Answer 2

Wernicke’s encephalopathy
Central pontine myelinolysis
Death
Small for dates babies

Question 3

What increases your likelihood of hyperemesis gravidarum

Answer 3

Multiple pregnancies
Molar pregnancies
Increased HCG

Question 4

Discuss the course of morning sickness?

Answer 4

Begins week 5-6
Peaks at week 11
Resolves by week 16

Question 5

What other conditions may look like hyperemesis gravidarum

Answer 5

UTI
Iatrogenic induced (e.g. iron tablets)
Addisons disease
Small bowel obstruction
Pancreatitis
Hepatitis
Hypercalceamia
Peptic ulcers
Gut infections

Question 6

How do you combat Morning sickness

Answer 6

Rest
Small carbohydrate meals
Carbonated drinks

Question 7

How do you manage hyperemesis gravidarum?

Answer 7

Admission to hospital for rehydration
Normal saline/Hartman's
Add potassium chloride if vomiting
Adapt fluid and electrolyte regimes due to day by day
Anti-emetics
Ant-acids (Gaviscon)
Thiamine supplementation

Question 8

What investigations are done to people who present to hospital with hyperemesis gravidarum?

Answer 8

Weight
Blood pressure
Heart rate
Urine dipstick (ketones, UTI, dehydration)
MSSU if UTI suspected
U&E's (hyponatremia, hypokalemia)
FBC (raised haematocrit)
LFT's (raised bilirubin, raised aminotransferase)
Pelvic USS (twins, molar)
TFT? (raised T4, reduced TFTH)?

Question 9

Give examples of commonly used anti-emetics

Answer 9

Cyclisine,
Metocloponide,
porcloperizine

Question 10

What further tests and investigations can be done for hyperemesis gravidarum

Answer 10

daily or tice daily urinalysis
Repeat blood tests for U&E
Record weight twice weakly 
Assess for thromboprophlaxis (doltiparum and TED's)
Ginger?
Vit B6? Helps nausuea
Ancupuncture (helps vomiting?)

Question 11

What happens if the HG is persistent?

Answer 11

NG or NJ tubing
TPN

If weight loss is less than 10%, consult consultant and diet

Question 12

What would you look to find out from a Urine dipstick in hyperemesis gravidarum?

Answer 12

Ketones,
UTI,
Dehydration

Question 13

Why would you do a MSSU in hyperemesis gravidarum?

Answer 13

If a UTI is suspected

Question 14

What does a full blood count indicate in hyperemesis gravidarum?

Answer 14

Raised haematocrit- dehydration present

Question 15

What should be noted about thyroid function tests?

Answer 15

60% come back low, do not need treated as not clinically relevant

Question 16

What can you do to help GORD

Answer 16

Anti-emetics
Ant-acids
Elevate head of bed
Frequent small meals`

Question 17

What treatment may be considered if initial treatment is not helping?

Answer 17

Change the anti-emetic therapy
Vitamin injection
Corticosteroids- (unsure if harmful to baby)
Refer to clinical psychologist
Alternative therapies