Complications

Question 1

What are the management options for hyperemesis gravidarum?

Answer 1

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
metoclopramide may cause extrapyramidal side effects
ginger and P6 (wrist) acupressure: CKS suggest these can be tried but there is little evidence of benefit
admission may be needed for IV hydration

Question 2

What would happen to the K+ levels in hyperemesis gravidarum?

Answer 2

They would be low due to excessive vomiting
Also there may be ketonuria
There may be blood in vomit due to mallory weis tear due to excessive vomiting

Question 3

What are the diagnostic criteria for hyperemesis gravidarum?

Answer 3

5% pre pregnancy weight loss
Dehydration
E- imbalance

Question 4

How do you classify the severity of N+V?

Answer 4

Validated scoring systems such as the Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of NVP.

Question 5

What are the complications of N+V?

Answer 5

Mallory weiss tear 
Wernickes encephalopathy 
Acute tubular necrosis 
Central pontine myelinolysis 
Fetal- SGA, pre term birth

Question 6

When can you use expectant management for ectopic pregnancy?

Answer 6

Expectant management of ectopics may be an option in those without acute symptoms and declining beta-HCG levels. Close monitoring is essential and intervention is advised if symptoms manifest or beta-HCG levels begin to rise.

Question 7

What is the best treatment of ectopics when the contralateral tube is healthy?

Answer 7

Salpingectomy, salpingotomy if not

Question 8

What would the examination findings be for an ectopic pregnancy?

Answer 8

abdominal tenderness
cervical excitation (also known as cervical motion tenderness)
adnexal mass: NICE advise NOT to examine for an adnexal mass due to an increased risk of rupturing the pregnancy. A pelvic examination to check for cervical excitation is however recommended

In the case of pregnancy of unknown location, serum bHCG levels >1,500 points toward a diagnosis of an ectopic pregnancy

Question 9

What is the history in an ectopic pregnancy?

Answer 9

A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
lower abdominal pain
due to tubal spasm
typically the first symptom
pain is usually constant and may be unilateral.
vaginal bleeding
usually less than a normal period
may be dark brown in colour
history of recent amenorrhoea
typically 6-8 weeks from the start of last period
if longer (e.g. 10 wks) this suggest another causes e.g. inevitable abortion
peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination
dizziness, fainting or syncope may be seen
symptoms of pregnancy such as breast tenderness may also be reported