Hyperemesis Gravidarum

Question 1

% of pregnancies? When is it most common?

Answer 1

1%

most common between 8-12 weeks m(may persist up to 20 weeks)

Question 2

What is it thought to be caused by?

Answer 2

B-HCG

Question 3

Associations?

Answer 3

Multipregnancy
Trophoblastic disease (molar?)
Hyperthyroidism
Nulliparity
Obesity

Question 4

What is protective against HG? clue: never tell your patients this

Answer 4

smoking

Question 5

1st line management

Answer 5

1st line - antihistamines i.e. promethazine or cyclizine

Question 6

Complications

Answer 6

Wernicke’s encephalopathy (thiamine deficiency)
Mallory-weiss tear (ask about blood in vomit)
Central pontine myelinosis (hyponatremia)
Maternal liver and renal failure

SGA, pre-term birth

Question 7

When would admission and referral to gynae be required?

Answer 7

Failure of oral antiemetics
Ketonuria
Weight loss >5%

–> urgent assessment and IV fluids

Question 8

Symptoms

Answer 8

N+V
weight loss
epigastric pain
ptyalism (inability to swallow saliva)
Haematamesis (mallory-weiss)

Question 9

Signs

Answer 9

Hypovolemia
Electrolyte imbalance
Heavy ketonuria (suggests dehydration)

Question 10

Investiogations

Answer 10

Urinalysis for ketones
MSU (exclude UTI)
Bloods: U+E (decreased K+, Na: metabolic acidosis)

Question 11

Management if not responding to oral antiemetic or ketonuria/5%weight loss?

Answer 11

Admit
IV fluids - avoid dextrose as can ppt wernicke's
Daily U+E - replace K if needed
NBM for 24 hrs
Antiemetics IV if not tolerating oral
Thiamine (pabrinex)

If all else fails - steroids (prednisilone/hydrocortisone)