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A - MSRA Obstetrics [16] > [16] Hyperemesis Gravidum > Flashcards

[16] Hyperemesis Gravidum Flashcards

1
Q

What is hyperemesis gravidum?

A

Intractable vomiting associated with weight loss of more than 5% of pre-pregnancy weight, dehydration, electrolyte imbalance, and the need for admission of hospital

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2
Q

In what % of pregnancies does hyperemesis gravidum occur?

A

Less than 1%

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3
Q

What are the risk factors for hyperemesis gravidum?

A
  • First pregnancy
  • Multiple pregnancy
  • Obesity
  • Prior or family history of hyperemesis gravidum
  • Trophoblastic disorder
  • History of eating disorder
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4
Q

When does hyperemesis gravidum occur?

A

Tends to start in the first trimester

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5
Q

How does the duration of hyperemesis gravidum compare to morning sickness?

A

Lasts significantly longer

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6
Q

How long does hyperemesis gravidum last?

A

Symptoms can continue until the give birth, or sometimes after

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7
Q

When is hyperemesis gravidum unlikely to be the cause of vomiting in pregnancy?

A

If it starts after 12 weeks gestation

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8
Q

What can the differential diagnoses of hyperemesis gravidum be divided into?

A
  • GI causes
  • Neurological causes
  • UTI
  • ENT disease
  • Drugs
  • Metabolic and endocrine disorders
  • Psychological disorders
  • Pregnancy associated conditions
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9
Q

What are the GI differentials for hyperemesis gravidum?

A
  • Gastroenteritis
  • Cholecysitis
  • Peptic ulceration
  • Hepatitis
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10
Q

What are the neurological differentials for hyperemesis gravidum?

A
  • Migraine

- Raised ICP

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11
Q

What are the ENT differentials for hyperemesis gravidum?

A
  • Labrynthitis

- Menieres disease

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12
Q

What drugs are differentials for hyperemesis gravidum?

A
  • Opioids

- Iron

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13
Q

What are the metabolic and endocrine differentials for hyperemesis gravidum?

A
  • Hypercalcaemia
  • Diabetes
  • Addison’s
  • Uraemia
  • Thyrotoxicosis
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14
Q

What can cause uraemia in pregnancy?

A
  • AKI

- CKD

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15
Q

What are the psychological differentials for hyperemesis gravidum?

A

Bulimia

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16
Q

What pregnancy associated conditions are differentials for hyperemesis gravidum?

A
  • Pre-eclampsia
  • Gestational trophoblastic disease
  • Twisted ovarian cyst
  • Fatty liver of pregnancy
17
Q

What investigation should be done in suspected hyperemesis gravidum?

A
  • Renal function and electrolytes
  • LFTs
  • MIdstream urine for infection and ketones
  • Ultrasound to exclude molar or multiple pregnancy
18
Q

What might the management of hyperemesis gravidum involve?

A
  • Advice
  • Fluid and electrolyte replacement
  • Nutritional support
  • Thiamine supplements
  • Anti-emetic medication
  • Corticosteroids
19
Q

What advice should be given in hyperemesis gravidum?

A

Dietary advice and support

20
Q

When might IV fluid and electrolyte replacement be required in hyperemesis gravidum?

A

In women who are severely dehydrated and ketotic

21
Q

What needs to be done regarding fluid and electrolyte balance in hyperemesis gravidum?

A

Fluid and electrolyte balance needs to be reassessed often

22
Q

How is nutritional support given in hyperemesis gravidum?

A

Can be enteral or parenteral

23
Q

What are the first-line anti-emetic medications in hyperemesis gravidum?

A

Promethazine or cyclazine

24
Q

What are the second-line anti-emetic medications in hyperemesis gravidum?

A

Metaclopramide or ondansteron

25
Q

When may corticosteroids be used in hyperemesis gravidum?

A

For intractable, severe cases

26
Q

What are the maternal complications of hyperemesis gravidum?

A
  • Weight loss
  • Dehydration
  • Acidosis
  • Hyponatraemia
  • Hypokalaemia
  • Vitamin deficiency
  • Mallory-Weiss tear of oesophagus
  • Retinal haemorrhages
  • Pneumothorax
27
Q

How much weight can be lost in hyperemesis gravidum?

A

10-20% of body weight

28
Q

What symptoms can hyponatraemia cause?

A
  • Lethargy
  • Headache
  • Confusion
  • Nausea and vomiting
  • Seizures
  • Respiratory arrest
29
Q

What can excessive correction of hyponatraemia lead to?

A

Central pontine myelinolysis

30
Q

What can hypokalaemia cause?

A
  • Muscle weakness

- Cardiac arrthyhmias

31
Q

What vitamins may be deficient in hyperemesis gravidum?

A
  • B1
  • B12
  • B6
32
Q

What might vitamin B1 deficiency lead to?

A

Wernicke’s encephalopathy

33
Q

What might vitamin B12 and B6 deficiency lead to?

A
  • Anaemia

- Peripheral neuropathies

34
Q

What are the fetal complications of hyperemesis gravidum?

A

Evidence that it’s associated with higher incidence of lower birth weight (SGA and premature babies)

35
Q

Is much known about the long-term health outcomes of babies born to mothers with hyperemesis gravidum?

A

No

A - MSRA Obstetrics [16] (61 decks)

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