Hyperemesis Gravidarum

Question 1

What is hyperemesis gravidarum?

Answer 1

Excessive vomiting in early pregnancy associated with ketosis and dehydration

Question 2

What is the aetiology of hyperemesis gravidarum?

Answer 2

Poorly understood but associated with BHCG levels.

RF multiple, GTD, previous HG, high BMI, nulliparity, low maternal age, hyperthyroid

Question 3

What is the epidemiology of hyperemesis gravidarum?

Answer 3

1% pregnant women

Question 4

What is the history/ exam of hyperemesis gravidarum?

Answer 4

Severe N&V, anorexia, wt loss

General: dehydration, weight loss, tachycardia, hypotension, dry mucous membranes

Question 5

What investigations do you do for hyperemesis gravidarum?

Answer 5

Utine: assess ketosis, exclude UTI

Bloods: FBC, BHCG, UE, LFT, TFT.

USS to exclude multiple and GTD.

Question 6

What is the management of hyperemesis gravidarum?

Answer 6

Admit, rehydrate with IV saline or Hartmann’s. NOT dextrose.

PO thiamine, consider thromboprophylaxis.

Severe – prednigolone, total parenteral nutrition.

Question 7

What are the complications/ prognosis of hyperemesis gravidarum?

Answer 7

MW tears, Wernickes encephalopathy from loss of B1, muscle wasting, VTE from dehydration, electrolyte disturbance, renal impairment. Good pgx with tx.