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Reproduction Pathology > Hyperemesis Gravidarum > Flashcards

Hyperemesis Gravidarum Flashcards

1
Q

What is the triad of hyperemesis gravidarum?

A

5% Pre pregnancy weight loss
Electrolyte imbalance
Dehydration

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2
Q

Risk factors for hyperemesis gravidarum

A 
Multiple pregnancies
Trophoblastic disease 
Hyperthyroidism 
Nulliparity
Obesity
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3
Q

What is associated with a decreased incidence of hyperemesis gravidarum?

A

Smoking

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4
Q

Definition of hyperemesis gravidarum

A

Excessive nausea and vomiting in pregnancy

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5
Q

Treatment of hyperemesis gravidarum

A

Anti emetic therapy
- Antihistamines 1st line (promethazine)
- Ondansetron and metoclopramide 2nd line
IV hydrationcs
TSH and T4 if no improvement over 48 hours
Refer to dietician for dietary advice if not improving after 48 hours
Treat GORD

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6
Q

Complications of hyperemesis gravidarum

A 
Wernickes encephalopathy 
Mallory weis tear 
Central pontine myelinolysis
Acute tubular necrosis
Small for gestational age of foetus
Pre term birth
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7
Q

Differential diagnosis of hyperemesis gravidarum

A 
UTIs
Multiple pregnancy 
Hydatiform mole
Reflux oesophagitis
Thyrotoxicosis
Addisons disease
Pancreatitis
Enteric infections
Infections
Hypercalcaemia
Peptic ulceration
Hepatitis 
Appendicitis
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8
Q

Investigations of hyperemesis gravidarum

A 
MSSU (UTI exacerbating or predisposing N + V)
Urine dipstick 
- proteinuria 
- ketones (Diabetes, catabolic)
Urine specific gravity (dehydration)
U and Es 
FBC
Patient weight 
USS
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9
Q

U and Es findings of hyperemesis gravidarum

A

Hyponatraemia
Hypokalaemia
Low urea

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10
Q

FBC findings in hyperemesis gravidarum

A

Haemtocrit increase in dehydration

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11
Q

Why is an USS an investigation of hyperemesis gravidarum?

A

To rule out multiple pregnancy and mole

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12
Q

If nausea and vomiting > 3 days, what may be done?

A 
Change anti emetic therapy
Prescribe ranitidine if reflux is a problem 
Vitamin injections
Steriods 
- 40mg initially then reduce as tolerated
NG or NJ feeding if weight loss > 10% body weight
Refer to clinical psychologist 
Alternative therapies
- aromatherapy
- hypnotherapy
- acupunture 
- "C bands"
- relaxation 
TPN
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13
Q

Examples of vitamin injections

A

Pabrinex IVHP

Solvito N

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14
Q

When does hyperemesis gravidarum occur in pregnancy?

A

Early pregnancy

- first trimester - 6 - 8 weeks of pregnancy

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15
Q

What is HG a diagnosis of?

A

Exclusion

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16
Q

Which hormone may cause HG?

A

Human chorionic gonadotrophin

17
Q

What is the level of HCG correlated to in HG?

A

The severity of vomiting

18
Q

Relation of HCG levels and thyroid levels

A

HCG shares a common alpha-sub unit with TSH and acts as a thyroid stimulator in patients with hyperemesis , hence elevated free thyroxine concentrations

19
Q

What is the fluid replacement of choice in HG?

A

Normal saline

20
Q

What makes up normal saline?

A

Sodium chloride 0.9%, 150mmol/L Na+

21
Q

What makes up Hartmanns?

A

Sodium chloride 0.6%, 131 mmol/L Na+

22
Q

Which fluid choice is contraindicated in HG and why?

A

Dextrose

It precipitates Wernickes encephalopathy and can worsen hyponatraemia

23
Q

How can hypokalaemia be treated in HG?

A

Infusion bags containing 40mmol/L of potassium chloride

24
Q

What should fluid replacement in HG have done to it?

A

Titrated against U and Es

25
Q

Examples of anti emetics that can be used in HG which do not respond to IV fluids and anti emetics alone

A

Cyclizine
Prochloperamide
Stemetil
Metoclopramide

26
Q

Complications of TPN

A

Phlebtitis

Thrombosis

27
Q

How quickly can the effects of TPN work?

A

Quickly

28
Q

How is TPN given?

A

Via a central line

29
Q

Cause of wernickes encephalopathy

A

Vitamin B1 (Thiamine) deficiency

30
Q

What can wernickes encephalopathy be precipitated by?

A

IV fluids containing dextrose

31
Q

Triad of wernickes encephalopathy

A

Confusion
Ataxia
Opthalmoplegia

32
Q

Incidence of foetal death in WE

A

40%

33
Q

Treatment of WE

A

IV/IM Thiamine replacement

34
Q

Recovery rate if WE also has retrograde amnesia, impaired ability to learn and confabulation (korasskoff psychosis)

A

50%

Reproduction Pathology (28 decks)

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