Hyperemesis gravidarum

Question 1

What condition can cause abnormal LFTs in the first trimester?

Answer 1

Hyperemesis gravidarum

Question 2

Definition of hyperemesis gravidarum

Answer 2

• due to high hCG levels
• Severe form of N/V
• Persistent and excessive during course of pregnancy
• Associated with weight loss
• Leads to dehydration, electrolyte imbalances, nutritional deficiencies

Question 3

Adverse pregnancy outcome a/w hyperemesis gravidarum

Answer 3

• IUGR
• Preterm birth more common
• Miscarriages
• Severe mental health issues in the mother*

Question 4

What endocrine derangement can be found on blood testing?

Answer 4

Hyperthyroidism
(high HCG → HCG is homologous to TSH)

Question 5

Medications to treat hyperemesis gravidarum

Answer 5

Non-pharm
- Ginger
- Wrist acupuncture (?)

Pharm
- Diclectin*** (pyridoxine (vit b6) + doxylamine (antihistamine))
- Ondansetron
- Metoclopramide
- Prednisolone

• Fluid replacement: IV Hartmann’s or Normal saline

Question 6

Why should dextrose 5% not be given on its own for IV hydration?

Answer 6

Dextrose 5% should not be given on its own for IV hydration as it can precipitate Wernicke’s encephalopathy due to lack of thiamine

Question 7

Obstetric conditions that predispose to hyperemesis gravidarum

Answer 7

Multiple pregnancies
Molar pregnancies