Early Pregnancy

Question 1

Nausea and vomiting affects how many women in pregnancy?

Answer 1

90%

Question 2

Hyperemesis gravidarum prevalence

Answer 2

0.3 - 3.6% women

Question 3

Cause of HG

Answer 3

Growth differentiation factor 15 (GDF-15)

Question 4

NVP natural history

Answer 4

Starts 4th to 7th week
Subsides 20th week
Affects 90% women

Question 5

Blood picture and metabolic state with HG

Answer 5

High haematocrit
Low urea
Hyponatraemia
Hypokalaemia
Hypochloraemic alkalosis
Metabolic acidosis if severe
Abnormal TFTs
Abnormal LFTs
Raised amylase

Question 6

Dosage of steroid therapy for refractory HG

Answer 6

IV hydrocortisone 100mg BD

Then

Oral prednisolone 40-50mg OD, gradually taper to minimum effective dose

Question 7

Ondansetron risk for HG

Answer 7

Orofacial defect:

11 per 10000 births background

14 per 10000 births with use in first trimester

Question 8

Metoclopramide use for HG

Answer 8

2nd line
Slow IV bolus over 3 minutes
30mg daily or 0.5mg/kg daily (lower dose)

Question 9

Wernicke encaphalopathy symptoms

Answer 9

Confusion
Blurred vision
Unsteadiness
Memory problems
Drowsiness

Question 10

Wernicke encephalopathy signs

Answer 10

Finger nose ataxia
Areflexia or hyporeflexia
Nystagmus
Ophthalmoplegia
Gait ataxia

Question 11

Rate of TOP due to HG

Answer 11

10%

Question 12

Risks of PEG-J tube for HG

Answer 12

Intestinal ischaemia
Dislodgement
Obstruction
Migration
Abscess
Fistula formation
Emphysema
Occlusion

Question 13

Risk of HG recurrence

Answer 13

15-81%

Question 14

Long term risks of HG

Answer 14

No increased risk all cause mortality
Higher risk of PND, anxiety and PTSD with long term mental health morbidity

Question 15

Self reported recurrence of HG

Answer 15

89%