Hyperemesis gravidarum Flashcards
What is hyperemesis gravidarum?
Persistent and severe vomiting during pregnancy which leads to weight loss, dehydration and electrolyte imbalance
What percentage of pregnant women are affected by hyperemesis?
0.3-0.6%
What are the symptoms of hyperemesis gravidarum?
Nausea and vomiting
When does normal vomiting and nausea in pregnancy begin?
4-7 weeks gestation
Reaches a peak in 9th week
When does nausea and vomiting settle in normal pregnancy?
Week 20
When is hyperemesis gravidarum diagnosed?
Prolonged and severe nausea and vomiting of pregnancy associated with more than 5% pre-pregnancy weight loss, dehydration and electrolyte imbalances
What is thought to be the cause of hyperemesis gravidarum?
Rapidly increasing levels of beta human chorionic gonadotrophin hormone
High levels stimulate the chemoreceptor trigger zone in the brainstem which feeds into the vomiting centre of the brain
Various other factors have been proposed including - genetics, immunological and biosocial components
What is bHCG released from?
Placenta
List some risk factors for hyperemesis gravidarum
First pregnancy Previous history of hyperemesis gravidarum Raised BMI Multiple pregnancy Hydatidiform mole
List the clinical features from the history of hyperemesis gravidarum
Age
Parity
Gestation
HPC - duration, frequency, oral intake, weight loss, urinary symptoms, bowel habit
PMH - history of HG, current/previous pregnancy, previous admission for HG, thyroid disease
DH - antiemetics used
What scoring system is used to classify the severity of hyperemesis gravidum
Pregnancy unique quantification of emesis score (PUQE)
What examination findings do we look for in hyperemesis gravidum?
Obs - temp, pulse, BP, RR, sats
Examination - signs of dehydration (dry mucous membranes and increased skin turgor), signs of muscle wasting, abdominal examination
List the differential diagnosis of hyperemesis gravidum
Gastroenteritis Cholecystic Hepatitis Pancreatitis Chronic H.pylori infection Peptic ulcers UTI/pyelonephritis Metabolic conditions Neurological conditions Drug induced
List the investigations for hyperemesis gravidum
Bedside - weight, urine dipstick (ketonuria)
Lab tests - mid stream urine, FBC, U&Es, blood glucose, LFTs, amylase, TFTs, ABG
Imaging - USS
Describe the management of hyperemesis gravidum
Severity of symptoms
Mild - managed in the community with oral antiemetics, oral hydration, dietary advice and reassurance
Moderate - should be managed with ambulatory daycare - IV fluids, parental antiemetics and thiamine (until ketonuria resolves)
Severe - inpatient management
Additional therapies - H2 antagonists or Proton pump inhibitors - reflux, oesophagitis or gastritis
- Thiamine - for prolonged vomiting to prevent wernickes encephalopathy
- Thromboprophylaxis - all women requiring admission
