Early pregnancy - nausea and vomiting in pregnancy

Question 1

when does nausea and vomiting in pregnancy start, peak and resolve?

Answer 1

first trimester (4-7 weeks)

peaking around 8-12 weeks gestation

resolves by 16-20 weeks

Question 2

what is the severe form of nausea and vomiting called?

Answer 2

hyperemesis gravidarum

Question 3

hat is thought to be responsible for nausea and vomiting?

Answer 3

placenta produces hCG

theoretically higher levels of hCG results in worse symptoms

Question 4

in what circumstances is nausea and vomiting more severe?

Answer 4

molar pregnancies

multiple pregnancies

worse in 1st pregnancy and in overweight/obese women

Question 5

RCOG guidelines for a diagnosis of hyperemesis gravidarum are protracted NVP plus what?

Answer 5

• More than 5 % weight loss compared with before pregnancy
• Dehydration
• Electrolyte imbalance

Question 6

what is the score used to assess severity of sickness?

Answer 6

Pregnancy-Unique Quantification of Emesis (PUQE)

• < 7: Mild
• 7 – 12: Moderate
• > 12: Severe

Question 7

how is NVP managed?

Answer 7

antiemetics

Question 8

name 4 antiemetics used in NVP in order of preference and known safety

Answer 8

1. Prochlorperazine (stemetil)
2. Cyclizine
3. Ondansetron
4. Metoclopramide

Question 9

what can be used if acid reflux is a problem?

Answer 9

ranitidine or omeprazole

Question 10

what are some complementary therapies that can be used to support women with NVP?

Answer 10

Ginger

acupressure on the wrist at the PC6 point may improve symptoms

Question 11

mild cases can be managed with oral antiemetics at home. when is admission considered?

Answer 11

• Unable to tolerate oral antiemetics or keep down any fluids
• More than 5 % weight loss compared with pre-pregnancy
• Ketones are present in the urine on a urine dipstick (2 + ketones on the urine dipstick is significant)
• Other medical conditions need treating that required admission

Question 12

moderate to severe cases may require ambulatory care or admission for what?

Answer 12

• IV or IM antiemetics
• IV fluids
• Daily monitoring of U&Es while having IV therapy
• Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
• Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission