7.5 Nausea and Vomiting of Pregnancy Flashcards
When does nausea and vomiting of pregnancy start, worsen and resolve?
Starts 4-7 weeks
Worse 10-12 weeks
Resolves 16-20 weeks
What causes nausea and vomiting of pregnancy (NVP)?
High levels of hCG from the placenta is thought to cause NVP
What is associated with worse nausea and vomiting of pregnancy?
- molar pregnancies (trophoblastic disease)
- multiple pregnancies
- first pregnancy
- obese / overweight
- hyperthyroid
How do you diagnose NVP?
Based on typical history, NV in first trimester and other causes excluded.
What is hyperemesis gravid arum?
Severe form of NVP. (1% of pregnancies)
What is the criteria for diagnosing hyperemesis gravidarum?
- “protracted” / prolonged nausea and vomiting plus:
- 5% loss of weight compared to pre-pregnancy
- dehydration
- electrolyte imbalance
What scoring system is used to assess the severity of NVP?
the Pregnancy-Unique Quantification of Emesis (PUQE) score.
mild <7
moderate 7-12
severe >12
What is the medical management of NVP and hyperemesis gravidarum?
First:
- cyclizine
- prochlorperazine / chlorpromazine
- promethazine
Second:
- ondansetron
- metoclopramide (extra-pyramidal effects)
Third:
(can consider hydrocortisone IV then pred)
What can you use in NVP and HG if acid reflux is a problem?
Ranitidine or omeprazole
What complementary therapies does RCOG recommend for NVP and HG?
- ginger
- acupressure on wrist at PC6 point
Mild cases of NVP can be managed at home, when should you consider admission?
- unable to tolerate oral antiemetics or keep fluids down
- more than 5% weight loss compared to pre-pregnancy
- ketones in urine dipstick++
Moderate to severe cases of NVP and HG may need what care / support?
Ambulatory care or admission offering:
- IV or IM antiemetics
- IV fluids (saline plus potassium)
- daily monitoring of U&Es
- thiamine supplementation (prevent Wernicke-Korsakoff)
- thromboprophylaxis (TED stocking and LMWH during admission)
What complications can occur from NVP and HG?
- Wernicke’s encephalopathy
- Mallory-Weiss tear
- central pontine myelinolysis
- acute tubular necrosis
- small for gestational age, pre-term birth