Antenatal

Question 1

Expected screening results for T21:

Answer 1

• Low alpha fetoprotein (AFP)
• Low oestriol
• High human chorionic gonadotrophin beta-subunit (-HCG)
• Low pregnancy-associated plasma protein A (PAPP-A)
• Thickened nuchal translucency

Question 2

Name the diagnostic criteria triad in hyperemesis gravid arum:

Answer 2

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 3

How common is HG and what is thought to be the cause?

Answer 3

It occurs in around 1% of pregnancies and is thought to be related to raised beta hCG levels.

Question 4

When does HG tend to present?

Answer 4

Hyperemesis gravidarum is most common between 8 and 12 weeks but may persist up to 20 weeks

Question 5

Conditions associated with HG?

Answer 5

Associations
multiple pregnancies
trophoblastic disease
hyperthyroidism
nulliparity
obesity

Question 6

Management of HG

Answer 6

• antihistamines should be used first-line (BNF suggests promethazine as first-line). Cyclizine is also recommended by Clinical Knowledge Summaries (CKS)
• ondansetron and metoclopramide may be used second-line
• Hydrate and replace electrolyte imbalance if necessary

Question 7

Complications of HG:

Answer 7

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