Hyperemesis gravidarum Flashcards
What is hyperemesis gravidarum?
N+V so severe often requring hospitalisation
Diagnosis of exclusion
Risk factors for hyperemesis gravidarum?
Increased levels of beta-hCG:
Multiple pregnancies
Trophoblastic disease
Nulliparity
Obesity
Family or personal history NVP
Smoking and hyperemesis?
Decreased incidence
Presentation of hyperemesis gravidarum?
N+V, not responding to anti emetics
Dehydration
Weightloss
Electrolye imbalance
when to admit mother with hypermesis?
Continuous so cannot keep down liquids or oral antiemetics
Continuous with ketonuria and or weight loss (5%+ body weight) despite treatment
What scoring system can help classify the severity of hyperemesis?
PUQE score
First line treatment for hyperemesis?
Antihistamine : oral cyclizine, promethazine
Phenothiazines : oral prochlorperazine
Conservative measures to manage N+V in pregnancy?
Avoid triggers and rest
Bland, plain food especially in the morning
Ginger
P6 acupressure
2nd line medication for hyperemesis?
Oral ondansetron : small risk of cleft lip though so discuss risks
Oral metoclopramide – extrapyramidal side effects
What is Meig’s syndrome?
Ovarian fibroma
Pleural effusion
Ascites
What fluid should be given with hyperemesis?
0.9% saline, potassiun infusion
NO DEXTROSE - thiamaine deficiency is common in these patients and dextrose increases bodily need for thiamine and so ppt wernickes encephalopathy
What are the RCOG guidelines for hypermesis diagnosis?
Hyperemesis gravidarum, diagnostic criteria triad:
- 5% pre-pregnancy
- weight loss
- dehydration
electrolyte imbalance
Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to ?
risk of extrapyramidal effects e.g dystonia
