7.5 Nausea and Vomiting of Pregnancy

Question 1

When does nausea and vomiting of pregnancy start, worsen and resolve?

Answer 1

Starts 4-7 weeks
Worse 10-12 weeks
Resolves 16-20 weeks

Question 2

What causes nausea and vomiting of pregnancy (NVP)?

Answer 2

High levels of hCG from the placenta is thought to cause NVP

Question 3

What is associated with worse nausea and vomiting of pregnancy?

Answer 3

• molar pregnancies (trophoblastic disease)
• multiple pregnancies
• first pregnancy
• obese / overweight
• hyperthyroid

Question 4

How do you diagnose NVP?

Answer 4

Based on typical history, NV in first trimester and other causes excluded.

Question 5

What is hyperemesis gravid arum?

Answer 5

Severe form of NVP. (1% of pregnancies)

Question 6

What is the criteria for diagnosing hyperemesis gravidarum?

Answer 6

• “protracted” / prolonged nausea and vomiting plus:
• 5% loss of weight compared to pre-pregnancy
• dehydration
• electrolyte imbalance

Question 7

What scoring system is used to assess the severity of NVP?

Answer 7

the Pregnancy-Unique Quantification of Emesis (PUQE) score.
mild <7
moderate 7-12
severe >12

Question 8

What is the medical management of NVP and hyperemesis gravidarum?

Answer 8

First:

• cyclizine
• prochlorperazine / chlorpromazine
• promethazine

Second:

• ondansetron
• metoclopramide (extra-pyramidal effects)

Third:
(can consider hydrocortisone IV then pred)

Question 9

What can you use in NVP and HG if acid reflux is a problem?

Answer 9

Ranitidine or omeprazole

Question 10

What complementary therapies does RCOG recommend for NVP and HG?

Answer 10

• ginger

- acupressure on wrist at PC6 point

Question 11

Mild cases of NVP can be managed at home, when should you consider admission?

Answer 11

• unable to tolerate oral antiemetics or keep fluids down
• more than 5% weight loss compared to pre-pregnancy
• ketones in urine dipstick++

Question 12

Moderate to severe cases of NVP and HG may need what care / support?

Answer 12

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)

Question 13

What complications can occur from NVP and HG?

Answer 13

• Wernicke’s encephalopathy
• Mallory-Weiss tear
• central pontine myelinolysis
• acute tubular necrosis
• small for gestational age, pre-term birth