Hyperemesis Gravidarum Flashcards
Hyperemesis gravidarum refers to ?
severe nausea and vomiting in pregnancy.
Hyperemesis gravidarum: this is diagnosed in patients with protracted nausea and vomiting and the following triad:
> 5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
Nausea and vomiting of pregnancy tends to develop between … - … weeks gestation.
Nausea and vomiting of pregnancy tends to develop between 4 - 7 weeks gestation.
Differential diagnosis for nausea and vomiting in pregnancy:
Hyperemesis gravidarum
Gastroenteritis
Acute pancreatitis
PUD
Gastritis
H.pylori infection
Cholecystitis
Urinary tract infections
Metabolic conditions (e.g. DKA)
Drug-induced nausea & vomiting
The …… scoring system can help to assess the severity of nausea and vomiting in pregnancy.
The Motherisk PUQE-24 scoring system can help to assess the severity of nausea and vomiting in pregnancy.
Investigations for hyperemesis gravidarum
The investigations ordered depend on the severity of symptoms; checking electrolytes, monitoring blood sugar and assessing for starvation ketosis may all be indicated.
Management for hyperemesis gravidarum
antiemetics and appropriate fluid rehydration.
First-line options: cyclizine, prochlorperazine, promethazine, chlorpromazine
Second-line options: metoclopramide, domperidone
Third-line options: corticosteroids (initially hydrocortisone IV converted to prednisolone orally when able)
Anti-emetic options for hyperemesis gravidarum
First-line options: cyclizine, prochlorperazine, promethazine, chlorpromazine
Second-line options: metoclopramide, domperidone
Third-line options: corticosteroids (initially hydrocortisone IV converted to prednisolone orally when able)
Ambulatory care for hyperemesis gravidarum
Women who require more regular review and IV therapies can be managed through ambulatory care services. Daily review with IV antiemetics, fluids and Pabrinex (vitamin C and B vitamins) and repeat blood tests when necessary. Urine dips are used to monitor for resolution of ketonuria.
