hyperemesis gravidarum

Question 1

diagnostic criteria- hyperemesis gravidum?

Answer 1

5% pre-pregnancy weight loss AND dehydration AND electrolyte imbalance

Question 2

what- hyperemesis gravidum?

Answer 2

Vomiting in first trimester common; only HG if excessive, protracted, altering quality of life

Question 3

pathopgysiology- nausea in pregnancy?

Answer 3

• Theplacenta produces hCG during pregnancy
• This hormone is thought to be responsible for nausea and vomiting

Question 4

when does hyperemesis gravidum tend to be worse?

Answer 4

• molar pregnancies
• multiple pregnancies
• trophoblastic diseases
• first pregnancy
• overweight or obese women

Question 5

presentation -hyperemesis gravidum?

Answer 5

-Dehydration, ketosis, electrolyte and nutritional disbalance
- Weight loss, altered liver function
- Signs of malnutrition
- Emotional instability, anxiety, severe cases can cause mental health issues e.g. depression

Question 6

what scans are advised and why in hyperemesis gravidum?

Answer 6

foetal growth scans
-because severe HG may be associated with fetal growth restriction

Question 7

management- hyperemesis gravidum?

Answer 7

Antiemetics:
First line= cyclizine, prochlorperazine
Second line= metoclopramide

Rehydration IV, electrolyte replacement

• Nutritional supplement
• Vitamin supplement: thiamine/pabrinex
• NG feeding, Total Parenteral Nutrition (TPN)
• Steroid use in recurrent, severe cases
• Thromboprophyaxis
• Can rarely extend to second trimester or even throughout pregnancy - in severe cases termination of pregnancy may be needed if health of woman is severely compromised

Question 8

scoring system for HG and what is severe?

Answer 8

PUQE score

severe >12

Question 9

treatment for moderate- severe?

Answer 9

IV/IM antiemetics (prochloroperazine/ cyclizine)
IV fluids
Daily monitoring of U&Es
Thiamine supplement/pabrinex (to prevent deficiency)
Thromnoprophylaxis

if hypokolaemia- potassium chloride

if recurrent- oral prednisolone