Hyperemesis Gravidarum Flashcards
what is thought to be the cause of hyperemesis gravidarum?
raised beta hCG levels
when does hyperemesis gravidarum typically present?
between 8-12 weeks but may persist up to 20 weeks
what are the risk factors for hyperemesis gravidarum?
- increased levels of beta-hCG (e.g. multiple pregnancies, trophoblastic disease)
- nulliparity
- obesity
- family or personal history of NVP
what is linked to decreased incidence of hyperemesis gravidarum?
smoking
when should you refer a patient with hyperemesis gravidarum?
- unable to keep down liquids or oral antiemetics
- ketonuria and/or weight loss (>5% of body weight)
- confirmed or suspected comorbidity
what triad constitutes a diagnosis of hyperemesis gravidarum?
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
what scoring system can be used to classify the severity of hyperemesis gravidarum?
pregnancy-unique quantification of emesis (PUQE)
what simple measures can be used to managed nausea and vomiting in pregnancy?
- rest and avoid triggers
- bland, plain food, particularly in the morning
- ginger
- P6 (wrist) acupressure
what are the first-line medications used in hyperemesis gravidarum?
- antihistamines = oral cyclizine or promethazine
- phenothiazines = oral prochlorperazine or chlorpromazine
what are the second-line medications used in hyperemesis gravidarum?
- oral ondansetron
- oral metoclopramide or domperidone
what is the risk with using ondasetron in pregnancy?
increased risk of the baby having a cleft lip/palate if used during the 1st trimester
what is the risk with using metoclopramide?
- may cause extrapyramidal side-effects
- not to be used for more than 5 days
what fluid is used to rehydrate in hyperemesis gravidarum?
normal saline with added potassium
what are the complications associated with hyperemesis gravidarum?
- dehydration
- AKI
- wernicke’s encephalopathy
- oesophagitis, mallory-weiss tear
- VTE
