Hyperemesis Gravidarum Flashcards

1
Q

Define hyperemesis gravidarum

A

Persistent and severe vomiting during pregnancy, which leads to TRIAD = >5% weight loss, dehydration and electrolyte imbalances

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2
Q

Outline the pathophysiology of hyperemesis gravidarum

A

It is thought to be due rapidly increasing levels of beta human chorionic gonadotrophin (hCG) hormone, which is released by the placenta.

High hCG stimulates the chemoreceptor trigger zone in the brainstem, which feeds into the vomiting centre of the brain.

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3
Q

How is nausea and vomiting in pregnancy assessed?

A

Classify the severity =

Pregnancy-Unique Quantification of Emesis (PUQE) score; 6 correlates to mild NVP, 7-12 moderate and 13-15 severe.

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4
Q

Outline a Hx for hyperemesis gravidarum

A

Age, parity and gestation

HPC

  • Duration N+V
  • Frequency of vomiting
  • Oral intake
  • Weight loss
  • Urinary symptoms
  • Bowel habit

PMH

  • History of HG: current and previous pregnancies
  • Previous admissions for HG
  • Thyroid disease

DH
- Anti-emetics used

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5
Q

Outline an examination for hyperemesis gravidarum

A

Observations

  • Temperature
  • Pulse
  • Blood pressure
  • Respiratory rate
  • Oxygen saturations

Clinical examination

  • Signs of dehydration: dry mucous membranes, increased skin turgor
  • Signs of muscle wasting
  • Abdo examination
  • Other examination guided by history
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6
Q

Give a DDx for N+V

A
  • Gastroenteritis
  • Cholecystitis
  • Hepatitis
  • Pancreatitis
  • Chronic H. Pylori infection
  • Peptic ulcers
  • UTI or pyelonephritis
  • Metabolic conditions
  • Neurological conditions
  • Drug-induced
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7
Q

How should hyperemesis gravidarum be investigated?

A

Bedside =

  • weight
  • dipstick (marked ketonuria, UTI)
  • PT

Lab

  • MSU
  • FBC, U+E, glucose, LFT, amylase, TFT, ABG

USS - exclude multiple preg/GTD

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8
Q

How should hyperemesis gravidarum be managed correctly?

A

Mild = community, oral anti-emetics CYCLIZINE, oral hydration
- Metoclopramide and ondansetron 2nd line, shouldn’t be used for >5d

Moderate = ambulatory daycare, IV fluids (no glucose), parenteral antiemetics, thiamine (replace folic acid)

Severe = inpatient, IV fluids (no glucose), ranitidine (H2RA), thiamine, thromboprophylaxis

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9
Q

Outline the prescription of antiemetics

A

First line:

  • Cyclizine
  • Prochlorperazine
  • Promethazine
  • Chlorpromazine

Second line:

  • Metoclopramide (max 5 days due to risk of extrapyramidal side effects)
  • Domperidone
  • Ondansetron

Third line:
- Hydrocortisone IV

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