2024 69 NVP & HG Flashcards
Which 2 tools are validated to classify the severity of NVP & HG?
PUQE: Pregnancy-Unique Quantification of Emesis
HELP: HyperEmesis Level Prediction
What are the 5 1st line antiemetics in NVP & HG?
Xonvea: doxylamine & pyridoxine
Cyclizine
Prochlorperazine
Promethazine
Chlorpromazine
What are the 3 2nd line treatments for NVP & HG?
Metoclopramide
Domperidone
Ondansetron
What is the 3rd line treatment for HG?
Steroids:
Hydrocortisone IV 100mg BD then
Prednisolone PO 40mg OD tapering 5-10mg per week
What is the impact of ondansetron on risk of orofacial defects?
14 per 10,000 vs 11 per 10,000
What rehydration fluid should be used?
Normal saline with KCl added
What is the regime for thiamine?
100mg TDS for all admitted or with severely reduced intake
What proportion of women are affected by NVP?
90%
What proportion of women are affected by HG?
0.3 to 3.6%
What is the major hypersensitivity in NVP & HG, with genetic variants identified?
GDF15: Growth Differentiation Factor 15
What are the conditions for diagnosing NVP?
Onset of N&V prior to 16/40 with other causes excluded
What are the conditions for diagnosing HG?
NVP with inability to E&D normally, strongly limiting ADLs, with dehydration
Windsor definition
For what proportion of women is NVP resolved by 20/40?
90%
What 4 electrolyte imbalances are associated with NVP & HG?
Hyponatraemia
Hypokalaemia
Hypouraemia
Ketonuria
What metabolic disturbance results from NVP & HG?
Metabolic hypochloraemic alkalosis
If severe, metabolic acidosis
What proportion of women with HG have abnormal biochemistry bloods?
TFTs: 67% raised T4 +/- suppressed TSH
LFTs: 40% rise in transaminases
What tool can be used to assess malnutrition?
MUST: Malnutrition Universal Screening Tool
What are the symptoms of depleted thiamine?
Tachycardia, weakness, decreased deep tendon reflexes
What is the only licensed treatment for NVP?
Xonvea:
Doxylamine & pyridoxine
Give 4 H1 antagonists used as antiemetics
Cyclizine
Promethazine
Cinnarizine
Doxylamine
Give 3 phenothiazines used as antiemetics
Prochlorperazine
Chlorpromazine
Perphenazine
Give 2 dopamine antagonists used as antiemetics
Metoclopramide
Domperidone
What is the mechanism of action of ondansetron in N&V?
5-HT3 antagonist
What is the regime for cyclizine?
50mg TDS PO, IV or IM
What is the regime for prochlorperazine?
5-10mg TDS-QDS PO
12.5mg TDS IM or IV
25mg OD PR
What is the regime for metoclopramide?
5-10mg TDS PO, IV, IM, SC
Max 5 days
Slow bolus 3 mins if IV
What is the regime for Xonvea?
20/20mg PO ON, additional 10/10 at morning & lunchtime if needed
How can HG impact on the fetus?
SGA
More likely to need resuscitation or ICU
