Hyperemesis gravidarum Flashcards
What is another term for hyperemesis gravidarum?
Morning sickness
What is used to describe a less troubling presentation of morning sickness?
‘nausea and vomiting of pregnancy’ (NVP)
What is used to describe a more severe presentation of morning sickness?
Hyperemesis gravidarum
When does morning sickness usually occur?
Between week 8-12 but can persist until week 20
What are the main RF for hyperemesis gravidarum?
increased levels of beta-hCG
nulliparity
obesity
family or personal history of NVP
What is morning sickness believed to be associated with?
Raised beta hCG levels
What can cause increases levels of beta-hCG?
multiple pregnancies
trophoblastic disease
Molar pregnancies
What is associated with a decreased risk of hyperemesis gravidarum ?
Smoking
When would admission for hyperemesis gravidarum be considered?
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)
What triad is required for a diagnosis of hyperemesis gravidarum can be made?
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
What simple measures can be recommended when someone first presents with morning sickness?
rest and avoid triggers e.g. odours
bland, plain food, particularly in the morning
ginger
P6 (wrist) acupressure
What is the first line medication for hyperemesis gravidarum?
Antihistamines:
oral cyclizine
promethazine
Which antihistamines can be given to help with morning sickness?
oral cyclizine
promethazine
What is the next first line medication for morning sickness?
phenothiazines:
oral prochlorperazine
chlorpromazine
What phenothiazines can be given to help with morning sickness?
oral prochlorperazine
chlorpromazine
What other medication can be given second line for hyperemesis gravidarum?
oral ondansetron
oral metoclopramide or domperidone
What is the problem with oral ondansetron?
It can cause cleft palate when used in the first trimester
What is the problem with metoclopramide?
It can cause extrapyramidal side effects so shouldn’t be used for more than 5 days
What is given to patients if they are admitted with hyperemesis gravidarum?
IV normal saline with added potassium is used to rehydrate
What are the possible complications of hyperemesis gravidarum?
acute kidney injury
Wernicke’s encephalopathy
oesophagitis, Mallory-Weiss tear
venous thromboembolism
What are the main 4 medications that can be used in the management of hyperemesis gravidarum?
Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide
What can be used to assess the severity of hyperemesis gravidarum?
Pregnancy-Unique Quantification of Emesis (PUQE) score
What does < 7 on the PUQE scale suggest?
Mild hyperemesis gravidarum
What does
7 – 12 on the PUQE scale suggest?
Moderate
