2024 69 NVP & HG

Question 1

Which 2 tools are validated to classify the severity of NVP & HG?

Answer 1

PUQE: Pregnancy-Unique Quantification of Emesis
HELP: HyperEmesis Level Prediction

Question 2

What are the 5 1st line antiemetics in NVP & HG?

Answer 2

Xonvea: doxylamine & pyridoxine
Cyclizine
Prochlorperazine
Promethazine
Chlorpromazine

Question 3

What are the 3 2nd line treatments for NVP & HG?

Answer 3

Metoclopramide
Domperidone
Ondansetron

Question 4

What is the 3rd line treatment for HG?

Answer 4

Steroids:
Hydrocortisone IV 100mg BD then
Prednisolone PO 40mg OD tapering 5-10mg per week

Question 5

What is the impact of ondansetron on risk of orofacial defects?

Answer 5

14 per 10,000 vs 11 per 10,000

Question 6

What rehydration fluid should be used?

Answer 6

Normal saline with KCl added

Question 7

What is the regime for thiamine?

Answer 7

100mg TDS for all admitted or with severely reduced intake

Question 8

What proportion of women are affected by NVP?

Answer 8

90%

Question 9

What proportion of women are affected by HG?

Answer 9

0.3 to 3.6%

Question 10

What is the major hypersensitivity in NVP & HG, with genetic variants identified?

Answer 10

GDF15: Growth Differentiation Factor 15

Question 11

What are the conditions for diagnosing NVP?

Answer 11

Onset of N&V prior to 16/40 with other causes excluded

Question 12

What are the conditions for diagnosing HG?

Answer 12

NVP with inability to E&D normally, strongly limiting ADLs, with dehydration
Windsor definition

Question 13

For what proportion of women is NVP resolved by 20/40?

Answer 13

90%

Question 14

What 4 electrolyte imbalances are associated with NVP & HG?

Answer 14

Hyponatraemia
Hypokalaemia
Hypouraemia
Ketonuria

Question 15

What metabolic disturbance results from NVP & HG?

Answer 15

Metabolic hypochloraemic alkalosis
If severe, metabolic acidosis

Question 16

What proportion of women with HG have abnormal biochemistry bloods?

Answer 16

TFTs: 67% raised T4 +/- suppressed TSH
LFTs: 40% rise in transaminases

Question 17

What tool can be used to assess malnutrition?

Answer 17

MUST: Malnutrition Universal Screening Tool

Question 18

What are the symptoms of depleted thiamine?

Answer 18

Tachycardia, weakness, decreased deep tendon reflexes

Question 19

What is the only licensed treatment for NVP?

Answer 19

Xonvea:
Doxylamine & pyridoxine

Question 20

Give 4 H1 antagonists used as antiemetics

Answer 20

Cyclizine
Promethazine
Cinnarizine
Doxylamine

Question 21

Give 3 phenothiazines used as antiemetics

Answer 21

Prochlorperazine
Chlorpromazine
Perphenazine

Question 22

Give 2 dopamine antagonists used as antiemetics

Answer 22

Metoclopramide
Domperidone

Question 23

What is the mechanism of action of ondansetron in N&V?

Answer 23

5-HT3 antagonist

Question 24

What is the regime for cyclizine?

Answer 24

50mg TDS PO, IV or IM

Question 25

What is the regime for prochlorperazine?

Answer 25

5-10mg TDS-QDS PO
12.5mg TDS IM or IV
25mg OD PR

Question 26

What is the regime for metoclopramide?

Answer 26

5-10mg TDS PO, IV, IM, SC
Max 5 days
Slow bolus 3 mins if IV

Question 27

What is the regime for Xonvea?

Answer 27

20/20mg PO ON, additional 10/10 at morning & lunchtime if needed

Question 28

How can HG impact on the fetus?

Answer 28

SGA
More likely to need resuscitation or ICU