Hyperemesis Gravidarum

Question 1

Complications of Hyperemesis gravidarum

Answer 1

• Anaemia (B12/Fe deficiency)
• Thiamine deficiency (Wernicke’s Encephalopathy)
• Depression
• Electrolyte disturbance- hyponatremia and risk of cerebral pontine demyelination
• DVT/PE
• Mallory-Weiss tears
• hypoglycaemia and DKA
• higher risk of premature birth (low risk of miscarriage)

Question 2

Risk factors for hyperemesis gravidarum

Answer 2

• First pregnancy
• Multiple pregnancy
• Gestational trophoblastic disease
• obesity
• FHx of HG
• Hx of eating disorder

Question 3

Clinical definition of Hyperemesis gravidarum

Answer 3

SEVERE nausea and vomiting during pregnancy causing weight loss and dehydration. (Dx of EXCLUSION)

(Weight loss more than 5% or 3 kg)
(ketones are evidence of dehydration)

Question 4

Symptoms of hyperemesis gravidarum

Answer 4

• Severe nausea and vomiting
• Functional impairment (can’t work or do ADLs)
• feeling faint
• PHYSICAL AND EMOTIONAL STRESS
• dehydration
• deficiencies (causing anaemia or peripheral neuropathy)

Question 5

Investigations for suspected hyperemesis gravidarum

Answer 5

• Elevated Blood Urea Nitrate levels (BUN)
• Ketones!
• UEC abnormalities (hyponatraemia, metabolic alkalosis)
• LFTs
• Urinalysis
• B-hCG (rule out GTD)

Question 6

Management of hyperemesis gravidarum

Answer 6

PRINCIPLES: FLUID AND BLAND DIET

• Fluids: cold drinks/ice chips (may require IV hydration)
• Bland diet
• Antiemetics (pyridoxine, metoclopramide, ondansetron, prochlorperazine)
• May be complicated by GORD (PPI)
• May require hospital admission (VTE PROPHYLAXIS!)
• Psychotherapy and psychosocial support is helpful

Question 7

Differential in hyperemesis gravidarum

Answer 7

• Infectious (UTI/Gastro)
• Metabolic (DKA)
• Endocrine (hyperthyroid)
• Gestational trophoblastic disease (Molar preg./choriocarcinoma)