7.5 Nausea and Vomiting of Pregnancy Flashcards

1
Q

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

A

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

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2
Q

What causes nausea and vomiting of pregnancy (NVP)?

A

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

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3
Q

What is associated with worse nausea and vomiting of pregnancy?

A
  • molar pregnancies (trophoblastic disease)
  • multiple pregnancies
  • first pregnancy
  • obese / overweight
  • hyperthyroid
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4
Q

How do you diagnose NVP?

A

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

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5
Q

What is hyperemesis gravid arum?

A

Severe form of NVP. (1% of pregnancies)

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6
Q

What is the criteria for diagnosing hyperemesis gravidarum?

A
  • “protracted” / prolonged nausea and vomiting plus:
  • 5% loss of weight compared to pre-pregnancy
  • dehydration
  • electrolyte imbalance
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7
Q

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

A

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

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8
Q

What is the medical management of NVP and hyperemesis gravidarum?

A

First:

  • cyclizine
  • prochlorperazine / chlorpromazine
  • promethazine

Second:

  • ondansetron
  • metoclopramide (extra-pyramidal effects)

Third:
(can consider hydrocortisone IV then pred)

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9
Q

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

A

Ranitidine or omeprazole

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10
Q

What complementary therapies does RCOG recommend for NVP and HG?

A
  • ginger

- acupressure on wrist at PC6 point

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11
Q

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

A
  • unable to tolerate oral antiemetics or keep fluids down
  • more than 5% weight loss compared to pre-pregnancy
  • ketones in urine dipstick++
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12
Q

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

A

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)
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13
Q

What complications can occur from NVP and HG?

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