Hyperemesis Gravidarum

Question 1

1. Definitiion

2. Epidemiology

Answer 1

1. Severe N&V causing dehydration, W loss(>5% pre-pregnancy W), ketosis or electrolyte disturbance.
2. Mild NVP in 50% pregnant women. Moderate NVP 5%. Hyperemesis 0.5-2%. NVP in 70-85% early pregnancies. usually before 9w. Resolve by 16w in 90%.

Question 2

Risk f

Answer 2

Hx. in prev pregnancy, motion sickness, migraines, FHx, Young, Obesity, Stress, 1st pregnancy, multiple pregnancies, molar pregnancy, hyperthyroidism

Question 3

Complications

Answer 3

Psychosocial, electrolyte disturbance, Wernicke’s encephalopathy, Oesophageal tears, malnutrition, IUGR, preterm birth, SGA, central pontine myelinolysis, ATN

Question 4

Investigations

Answer 4

1. Obs:
   - HR, BP, Weight
2. Blood:
   - U&E, Glucose, LFTs
3. Urine
   - MSU, Ketones
4. USS
   - multiple pregnancy, molar pregnancy

Question 5

Admission

Answer 5

1. Severe symptoms despite 24h medication
2. evidence of dehydration/medical complications
3. Persistent N&V, can’t keep down anti-emetics

*diabetic may need specialist input

Question 6

Treatment

Answer 6

1. Reassurance
2. Ginger and P6 acupressure(little evidence), small frequent meals high carb, low fat; biscuits 20 mins before getting up.
3. Seek medical advice if:
   - v. dark urine/X urination for 8h
   - abdo pain/fever
   - severe weakness/feeling faint
   - vomit blood
   - X keep down food or fluids for 24h
4. Anti-emetic
   - Cyclizine/promethazine as 1st line then review after 1w
   - switch to metoclopramide/prochlorperazine/ondansetron and review weekly
   - stop anti-emetic around 12-16w
5. Consider VTE prophylaxis
6. Daily weight

Question 7

Persistent vomiting despite treatments:

Answer 7

1. Ondansetron

2. Thiamine to prevent Wernicke’s encephalopathy

Question 8

Other causes:

Answer 8

Gastroenteritis, UTI, Appendicitis