Hyperemesis gravidarum Flashcards
what is it?
extreme nausea and vomiting with pregnancy
what is thought to be the cause?
beta hcg levels raised
when is it most common?
8-12 weeks
may persist up to 20 weeks
what is it associated with?
multiple pregnancies
trophoblastic disease
hyperthyroidism
nulliparity
obesity
what decreases incidence of hyperemesis
smoking
when should you consider admission
continued n + v and is unable to keep down ;liquids or oral antiemetics
continued n+v with ketonuria +/- weight loss despite oral antiemetics
confirmed or suspected co-morbidity - unable to tolerate oral antibiotics for UTI
lower threshold if woman has co-existing condition that maybe adversely affected by n + v
triad of diagnosing hyperemesis gravidarum
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
scoring system
Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of NVP.
management
- antihistamines first line
- oral cyclizine or oral promethazine or oral prochorperazine
- second line ondansetron or metoclopromide
- ginger and acupressure
- iv fluid hydration - admit
complications
Wernicke’s encephalopathy
Mallory-Weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestational age, pre-term birth
