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Hyperemesis gravidarum Flashcards

1
Q

What is another term for hyperemesis gravidarum?

A

Morning sickness

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2
Q

What is used to describe a less troubling presentation of morning sickness?

A

‘nausea and vomiting of pregnancy’ (NVP)

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3
Q

What is used to describe a more severe presentation of morning sickness?

A

Hyperemesis gravidarum

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4
Q

When does morning sickness usually occur?

A

Between week 8-12 but can persist until week 20

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5
Q

What are the main RF for hyperemesis gravidarum?

A

increased levels of beta-hCG
nulliparity
obesity
family or personal history of NVP

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6
Q

What is morning sickness believed to be associated with?

A

Raised beta hCG levels

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7
Q

What can cause increases levels of beta-hCG?

A

multiple pregnancies
trophoblastic disease
Molar pregnancies

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8
Q

What is associated with a decreased risk of hyperemesis gravidarum ?

A

Smoking

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9
Q

When would admission for hyperemesis gravidarum be considered?

A

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (e.g. unable to tolerate oral antibiotics for a urinary tract infection)

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10
Q

What triad is required for a diagnosis of hyperemesis gravidarum can be made?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

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11
Q

What simple measures can be recommended when someone first presents with morning sickness?

A

rest and avoid triggers e.g. odours
bland, plain food, particularly in the morning
ginger
P6 (wrist) acupressure

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12
Q

What is the first line medication for hyperemesis gravidarum?

A

Antihistamines:
oral cyclizine
promethazine

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13
Q

Which antihistamines can be given to help with morning sickness?

A

oral cyclizine
promethazine

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14
Q

What is the next first line medication for morning sickness?

A

phenothiazines:
oral prochlorperazine
chlorpromazine

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15
Q

What phenothiazines can be given to help with morning sickness?

A

oral prochlorperazine
chlorpromazine

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16
Q

What other medication can be given second line for hyperemesis gravidarum?

A

oral ondansetron
oral metoclopramide or domperidone

17
Q

What is the problem with oral ondansetron?

A

It can cause cleft palate when used in the first trimester

18
Q

What is the problem with metoclopramide?

A

It can cause extrapyramidal side effects so shouldn’t be used for more than 5 days

19
Q

What is given to patients if they are admitted with hyperemesis gravidarum?

A

IV normal saline with added potassium is used to rehydrate

20
Q

What are the possible complications of hyperemesis gravidarum?

A

acute kidney injury
Wernicke’s encephalopathy
oesophagitis, Mallory-Weiss tear
venous thromboembolism

21
Q

What are the main 4 medications that can be used in the management of hyperemesis gravidarum?

A

Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide

22
Q

What can be used to assess the severity of hyperemesis gravidarum?

A

Pregnancy-Unique Quantification of Emesis (PUQE) score

23
Q

What does < 7 on the PUQE scale suggest?

A

Mild hyperemesis gravidarum

24
Q

What does
7 – 12 on the PUQE scale suggest?

A

Moderate

25
Q

What does > 12 on the PUQE scale suggest?

A

Severe

26
Q

When would you consider admission for someone with hyperemesis gravidarum?

A

Unable to tolerate oral antiemetics or keep down any fluids
More than 5 % weight loss compared
Ketones are present in the urine
Other medical conditions

27
Q

Why might you give Thiamine supplementation to someone with hyperemesis gravidarum?

A

To prevent deficiency (prevents Wernicke-Korsakoff syndrome)

28
Q

Why might you give Thromboprophylaxis (TED stocking and low molecular weight heparin) to someone with hyperemesis gravidarum?

A

To prevent VTE

29
Q

What electrolyte imbalance can occur in hyperemesis gravidarum?

A

Hypokalaemia
Hyponatraemia

30
Q

What medicaion can you consider if teh vomiting is uncontrollable?

A

Prednisolone or Hydrocortisone

31
Q

What would you prescrive to prevent wernicke’s encephalopathy developing?

A

5mg/day folic acid and Thiamine- Pabrinex

32
Q

Why might someone w ith hyperemesis gravidarium develop haematemesis?

A

Due to a mallory weiss tear

33
Q

Why might someone with hyperemesis gravidarum develop polyneuritis?

A

Decrease in B vitamins

34
Q

What is hyperemesis gravidarum?

A

Persisting vomiting in pregnancy which results in weight loss and ketosis

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