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Obstetrics > Early Pregnancy: Hyperemesis Gravidarum > Flashcards

Early Pregnancy: Hyperemesis Gravidarum Flashcards

1
Q

What is hyperemesis gravidarum

A

Excessive nausea and vomiting during pregnancy

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2
Q

When does nausea and vomiting in pregnancy usually start and peak

A

Starts at 4-7W.

Peaks 8-12W.

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3
Q

When does nausea and vomiting during pregnancy usually settle by

A

20W.

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4
Q

What is the criteria to diagnose hyperemesis gravidarum

A

Prolonged and severe nausea and vomiting during pregnancy with:

  1. Weight Loss
  2. Dehydration
  3. Electrolyte imbalances
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5
Q

What 3 factors about the pregnancy increase risk of hyperemesis gravidarum

A

First pregnancy
Multiple pregnancy
Molar pregnancy

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6
Q

What 3 factors about the women increase risk of hypermesis gravidarum

A

High BMI

Previous hyperemesis gravidarum

Hyperthyroidism

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7
Q

What is a protective factor for hyperemesis gravidarum

A

Smoking

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8
Q

In addition to N+V, weight loss, dehydration, electrolyte imbalance - what may be seen in hyperemesis gravidarum

A

Ketosis

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9
Q

what scoring system is used to grade hyperemesis gravidarum

A

Pregnancy unique quantification of emesis (PUQE)

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10
Q

What PUQE score defines mild hyperemesis gravidaurm

A

6

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11
Q

What PUQE score defines moderate hyperemesis gravidaurm

A

7-12

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12
Q

What PUQE score defines severe hyperemesis gravidaurm

A

13-15

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13
Q

Describe pathophysiology of hyperemesis gravidarum

A

Caused by release of bHCG from the placenta which enters chemoreceptive trigger zone to stimulate vomiting.

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14
Q

What bedside investigations are ordered in hyperemesis gravidarum

A

Urinalysis - for ketonuria

BMI - risk factor

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15
Q

What U+E would be expected in hyperemesis gravidarum

A

Hyponatraemia

Hypokalaemia

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16
Q

How is mild hyperemesis gravidarum managed

A

Community:

  • Oral Anti-Emetics
  • Oral Fluids
17
Q

How is moderate hyperemesis managed

A

Ambulatory:

  • IV anti-emetics
  • IV Fluids
18
Q

How is severe hyperemesis gravidarum managed

A

Inpatient

19
Q

What are the 3 criteria for admission with hyperemesis gravidarum

A
  1. N+V - unable to keep liquids or anti-emetics down
  2. N+V - with ketonuria
  3. N+V- with 5% pre-pregnancy weight-loss
  4. Confirmed or suspected co-morbditiy
20
Q

What anti-emetics are used first-line

A

1: Promethazine
2: Cyclizine

21
Q

What anti-emetics are used second line

A

Ondanestron

Metclopramide

22
Q

What is third-line management for hyperemesis gravidarum

A

IV hydrocortisone

23
Q

Why should thiamine be given in hyperemesis gravidarum

A

To prevent wernicke’s encephalopathy

24
Q

What are 4 complications of hyperemesis gravidarum for the women

A

Wernicke’s encephalopathy
ATN
Mallory-Weiss
Central pontine myelinolysis

25
Q

What are 2 complications to the foetus of hyperemesis gravidarum

A

Pre-term

IUGR

Obstetrics (27 decks)

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