3: Hyperemesis

Question 1

What is hyperemesis?

Answer 1

Severe N&V in pregnancy a/w weight loss of >5% fluid loss or dehydration

Question 2

Which features of history/examination might indicate admission for a woman with hyperemesis?

Answer 2

Signs/symptoms of volume depletion, ketosis and electrolyte imbalance.

Question 3

DDx for hyperemesis

Answer 3

1. Molar pregnancy
2. Multiple gestation
3. Hyponatremia
4. Non-pregnancy causes e.g. appendicitis, pancreatitis, cholecystitis, bowel obstruction

Question 4

Cx of hyperemesis

Answer 4

1. Poor absorption: vitamin deficiency (wernicke’s, anaemia, peripheral neuropathy)
2. Haemoconcentration (VTE)
3. Structural damage (Mallory Weiss)
4. Depression
5. Hyponatremia

Question 5

Investigations for hyperemesis

Answer 5

Lab

• Bloods: FBC, U&E, LFT
• Urine: ketones, bacteriuria

USS
- Transvaginal (intrauterine pregnancy, multiple)

Question 6

Mx of hyperemesis

Answer 6

1. Dehydration and electrolyte imbalance
   - IV 0.9% Normal saline
2. Prophylaxis against cx
   - Folic acid, iodine, thiamine and pyridoxine
3. Sx management
   - Metoclopramide, cyclizine, ondansetron, prochlorperazine

Other: support, diet and lifestyle modifications, oral ginger, corticosteroids (severe)