Early Pregnancy: Hyperemesis Gravidarum Flashcards
What is hyperemesis gravidarum
Excessive nausea and vomiting during pregnancy
When does nausea and vomiting in pregnancy usually start and peak
Starts at 4-7W.
Peaks 8-12W.
When does nausea and vomiting during pregnancy usually settle by
20W.
What is the criteria to diagnose hyperemesis gravidarum
Prolonged and severe nausea and vomiting during pregnancy with:
- Weight Loss
- Dehydration
- Electrolyte imbalances
What 3 factors about the pregnancy increase risk of hyperemesis gravidarum
First pregnancy
Multiple pregnancy
Molar pregnancy
What 3 factors about the women increase risk of hypermesis gravidarum
High BMI
Previous hyperemesis gravidarum
Hyperthyroidism
What is a protective factor for hyperemesis gravidarum
Smoking
In addition to N+V, weight loss, dehydration, electrolyte imbalance - what may be seen in hyperemesis gravidarum
Ketosis
what scoring system is used to grade hyperemesis gravidarum
Pregnancy unique quantification of emesis (PUQE)
What PUQE score defines mild hyperemesis gravidaurm
6
What PUQE score defines moderate hyperemesis gravidaurm
7-12
What PUQE score defines severe hyperemesis gravidaurm
13-15
Describe pathophysiology of hyperemesis gravidarum
Caused by release of bHCG from the placenta which enters chemoreceptive trigger zone to stimulate vomiting.
What bedside investigations are ordered in hyperemesis gravidarum
Urinalysis - for ketonuria
BMI - risk factor
What U+E would be expected in hyperemesis gravidarum
Hyponatraemia
Hypokalaemia
How is mild hyperemesis gravidarum managed
Community:
- Oral Anti-Emetics
- Oral Fluids
How is moderate hyperemesis managed
Ambulatory:
- IV anti-emetics
- IV Fluids
How is severe hyperemesis gravidarum managed
Inpatient
What are the 3 criteria for admission with hyperemesis gravidarum
- N+V - unable to keep liquids or anti-emetics down
- N+V - with ketonuria
- N+V- with 5% pre-pregnancy weight-loss
- Confirmed or suspected co-morbditiy
What anti-emetics are used first-line
1: Promethazine
2: Cyclizine
What anti-emetics are used second line
Ondanestron
Metclopramide
What is third-line management for hyperemesis gravidarum
IV hydrocortisone
Why should thiamine be given in hyperemesis gravidarum
To prevent wernicke’s encephalopathy
What are 4 complications of hyperemesis gravidarum for the women
Wernicke’s encephalopathy
ATN
Mallory-Weiss
Central pontine myelinolysis
What are 2 complications to the foetus of hyperemesis gravidarum
Pre-term
IUGR
