Hyperemesis gravidarum

Question 1

Name 3 criteria for hyperemesis gravidarum that separate it from morning sickness

Answer 1

Persistent vomiting accompanied by LOW > 5% of body weight +/- dehydration and ketonuria (body in starvation mode)

Question 2

When is hyperemesis gravidarum most likely to begin? How long does it last for?

Answer 2

4-10 weeks gestational age. Can last for entire pregnancy, but usually improves in second half

Question 3

Name 3 Ddx for hyperemesis gravidarum, and Ix to distinguish between them

Answer 3

Morning sickness; look for drop in standing BP, urine ketones, LOW
Hyperthyroidism: Free T4 and TSH
Multiple pregnancy or GTD: U/S
Infection (UTI, gastro) - urinanalysis

Question 4

Name 4 non-pharmaceutical and 4 pharmaceutical Mx for hyperemesis gravidarum

Answer 4

Non-pharm: ginger, diet, avoid triggers, psychological counselling
Pharm: Vitamin B6, anti-emetics, anti-histamines, dopamine antagonists (pro-motility), IV fluids or supplemental nutrition if needed, high-dose prednisolone