Hyperemesis Gravidarum

Question 1

What is hyperemesis gravidarum

Answer 1

Hyperemesis Gravidum is Excessive Vomiting,

incidence of 1 per 1000; Women with Multiple or Molar pregnancies at higher risk

Question 2

Features of hyperemesis gravidarum

Answer 2

Severe, Persistent and Intractable Vomiting, Weight Loss, Muscle Wasting, Dehydration, Inability to swallow saliva (Ptysalism), Hypovolaemia, Electrolyte disorders, Haematemesis
secondary to Mallory-Weiss Tears

Question 3

Consequences of hyperemesis gravidarum

Answer 3

Liver failure, Renal Failure can occur in severe cases; Hyponatraemia, and CPM from rapid reversal; Thiamine deficiency can lead to Wernicke’s; Foetal IUGR and death possible

Question 4

Investigations of Hyperemesis

Answer 4

• Urinalysis – Urinary Ketones
• MSU to exclude UTI
• FBC, U/Es, LFTs
• Ultrasound for Reassurance and exclude Multiple/Molar pregnancies
• No role for TFTs, often transiently abnormal

Question 5

Treatment of Hyperemesis: Non pharmacological

Answer 5

• Admit if not tolerating Oral fluids; IV fluids (NaCl or Hartmann; Glucose solutions could precipitate Wernicke’s); Daily U/Es and replace K if needed
• NBM for 24hrs and reintroduce light diet as tolerated

Question 6

Treatment of Hyperemesis: Pharmacological

Answer 6

• Antiemetics – If no response to IV fluid and Electrolyte Replacement
o Promethazine or Cyclizine first-line
o Prochlorperazine or Metoclopramide second-line
o Ondansetron or Granisetron (unlicensed); third-line
• If still unresponsive, Trial of Steroids (Prednisolone 40 – 50mg PO, or Hydrocort 100mg IV
over 12hrs; Efficacy unknown