Early Pregnancy - Hyperemesis Gravidarum

Question 1

Common Course of Nausea and Vomiting in Pregnancy and Epidemiology.

Answer 1

1. Starts in Trimester 1 at Weeks 4-7.
2. Peaks at Weeks 8-12.
3. Resolves by Week 16-20.
4. 1% of Pregnancies.

Question 2

Differentials of NVP in Pregnancy (5).

Answer 2

1. Infections e.g. Gastroenteritis, UTI, Hepatitis, Meningitis.
2. GI Problems e.g. Appendicitis, Cholecystitis, Bowel Obstruction, Peptic Ulcers, Pancreatitis, H. pylori.
3. Metabolic Problems e.g. DKA, Thyrotoxicosis.
4. Drug Toxicity.
5. Molar Pregnancy.

Question 3

Aetiology of NVP (4).

Answer 3

1. Placenta produces hCG during pregnancy.
2. Higher levels of hCG result in worse symptoms.
3. Also worse in nulliparity (1st pregnancy) and obese mothers.
4. Associated with Hyperthyroidism and Not Smoking.

Question 4

Investigation of NVP.

Answer 4

PUQE : Pregnancy-Unique Quantification of Emesis (15). MILD - Below 7.
MODERATE - 7-12.
SEVERE - 12+.

Question 5

Management of NVP at Home.

Answer 5

1. 1st Line - Antihistamines.
2. Antiemetics (PCOM) : Prochlorperazine, Cyclizine, Ondansetron and Metoclopramide (Extra-Pyramidal Side Effects).
3. Complementary : Ginger and Acupressure on Inner Wrist at PC6 Point.

Question 6

Admission Criteria of NVP (4).

Answer 6

1. Unable to Tolerate Oral Antiemetics or Keep Down Any Fluids.
2. > 5% Weight Loss Compared to Pre-Pregnancy.
3. Ketonuria (2+ Ketones).
4. Other Medical Conditions Requiring Admission e.g. UTI.

Question 7

Management of NVP in Hospital (3).

Answer 7

1. IV/IM Anti-Emetics.
2. IV Fluids (Normal Saline with KCl).
3. Thiamine (Prevent Wernicke-Korsakoff Syndrome).

Question 8

Definition of Hyperemesis Gravidarum.

Answer 8

A severe form of nausea and vomiting in pregnancy. Protracted NVP Plus :

1. More than 5% Pre-Pregnancy Weight Loss.
2. Dehydration.
3. Electrolyte Imbalance.

Question 9

Complications of NVP (5).

Answer 9

1. Wernicke’s Encephalopathy.
2. Mallory-Weiss Tear.
3. Central Pontine Myelinolysis.
4. Acute Tubular Necrosis.
5. Foetal Complications e.g. SGA, Pre-Term Birth.