Hyperemesis gravidarum Flashcards
What is hyperemesis gravidarum (RF)
80% if woman get vomiting and nausea during pregnancy -worse 1/3 trimester due to bHCG –> emesis gravidarum
but 1% get a worse form - hyperemesis gravidarum
RF-SMOKING IS PROTECTOR
Nulliparti, multiple preg, Obesity, Hyperthyroid, Trophoblastic disease, pmh HG
Sx of hyperemesis gravidarum
Vomiting and inability to tolerate fluids and food —
start between 4th and 7th week
peaks at 8th
resolve by 20th
use RCOG diagnositic criteria –NEED-
need - 5% pre-pre weight loss
Dehydration
electrolyte imabalance
Important exclude other - abdopain, urinary sx, infection, drugs, Hpylori
OE/- obs, weight, dehydration Signs, muscle wasting
Ix of hyperemesis gravidarum
Body weight is crucial for diagnosis
urine dipstick for UTI and KETONES
U&E for dehydration
Obs
Use PUQE criteria from RCOG to determine severity
PUQE q’s-
in last 24h how long as felt nauseous (highest is 6h)
How many times vomit in 24h- (7x or more max)
wretiching/heaved without brining things up in last 24h? (max 7x )
Severe -admit
Admission criterias /severe
Unable to keep down fluids, ketouria, weight loss 5%, comorbid (diabetes)
Mx of hyperemesis gravidarum
Admission criterias /severe
Unable to keep down fluids, ketouria, weight loss 5%, comorbid (diabetes)
–> IV saline with KCL and Thiamine
IF DEHYDRATED GIVE VTE -LMWH
Mild/moderate - can be treated in community
11st line- antihistamines (promethazine, cyclizine_
2nd-antiemetics (ondansteron, metoclop)
if use, reassess in 24h
3rd- steroids -IV hydroxcortisone BD
combinations can be used if 1 isnt doing it
and always check psych effects
IF DEHYDRATED GIVE VTE -LMWH
Prognosis/complictions of Hyperemesis gravidarum for mother and foetus
Maternal - mainly VTE, Wernickes, Hypokalemia, hyponatremia
dehyrdation, malloryweiss tears,
cetnral pontine myelinosis from replacing NA
Acute tubular necrosis/AKI
FOetal -
IUGR, PTL, termination
