Hyperemesis gravidarum

Question 1

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days. Discuss your management

Answer 1

History
Examination
Diagnosis and definition
Investigations
Differential diagnosis
Complications
Management
Discharge plan

Question 2

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

History

Answer 2

Main complaint
Any medication
Stool
Urine
Rest of history

Question 3

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Examination

Answer 3

Entire examination

Dehydration

Question 4

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Diagnosis and definition

Answer 4

Hyperemesis gravidarum
Severe protractory vomiting appearing before 20w GA not associated with other conditions and is of such severity it requires hospital admission

Question 5

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Investigations

Answer 5

U/S
FBC
U+E
LFT
TFT
Glucose
Look for hypokalemia
Urine dipstick
Urine MCS

Question 6

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Differential diagnosis

Answer 6

UTI
Gastroenteritis
Thyrotoxicosis
Hepatitis
Appendicitis
Cholecystitis

Question 7

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Complications

Answer 7

Vitamin B -> Wernicke’s, Korsakoff
Haematemesis -> mallor weiss tears
Renal impairment -> ATN
Psychological -> resents pregnancy, wants TOP

Question 8

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Management

Answer 8

1. Supportive care
2. Fluids - no dextrose
3. Replace electrolytes
4. Antiemetics
5. Thiamine and folate
6. Antacids
7. Heparin anticoagulant
8. Daily monitoring
9. No ketonuria and eating/drinking -> discharge

Question 9

28yo primigravida with persistent vomiting who is pregnant. Vomits up to 10 times a day and cannot tolerate food/water in last 3 days.

Discharge plan

Answer 9

F/U at high risk 4weekly
MVT
1st trimester screen biochem and scan 11-14w
18-22w anomaly scan
4weekly growth scans in 3rd trimester
Aspirin <16w 
Repeat Coombs
Deliver