Hyperemesis gravidarum

Question 1

What is it defined as?

Answer 1

persistent vomiting in pregnancy causing weight loss and ketosis

Question 2

What are the RFs

Answer 2

→ Multiple pregnancies
→ Molar pregnancies
→ Prev. HG

Question 3

What is the cause thought to be?

Answer 3

high hCG levels

Question 4

what is the presentation?

Answer 4

inability to keep anything down
weight loss 
malnutrition + dehydration
hypovolaemia
tachycardia
postural hypotension
electrolyte disturbance - hypokalaemia, hyponatraemic shock

Question 5

What are potential complications of this?

Answer 5

mallory weiss tears causing haematemesis
ptyalism (inability to swallow saliva)
liver + renal failure

Question 6

what are the appropriate ix

Answer 6

1. Urine dip - ketones and UTI
2. FBC - raised haematocrit, U&E to exclude hypokalaemia or hyponatraemia
3. US - multiple pregnancy and exclude a mole
4. TFTs if sx of hyperthyroidism

Question 7

When should someone be admitted to hospital?

Answer 7

− If unable to keep anything down despite oral anti-emetics
− If dehydrated for rehydration
− Correcting metabolic disturbances

Question 8

What is the general treatment

Answer 8

1. Fluid replacement - 0.9% NaCl + K or Hartmann’s
2. Anti-emetics - promethazine, cyclising, metoclopramide
3. CS - prednisone/ hydrocortisone
4. Thiamine (pabrinex) to prevent Wernicke’s encephalopathy
5. Thromboprophylaxis as high risk of VTE (enoxaparin)