Hyperemesis Gravidum Flashcards
What is hyperemesis gravidum?
Intractable vomiting associated with weight loss of more than 5% of pre-pregnancy weight, dehydration, electrolyte imbalance, and the need for admission of hospital
In what % of pregnancies does hyperemesis gravidum occur?
Less than 1%
What are the risk factors for hyperemesis gravidum?
- First pregnancy
- Multiple pregnancy
- Obesity
- Prior or family history of hyperemesis gravidum
- Trophoblastic disorder
- History of eating disorder
When does hyperemesis gravidum occur?
Tends to start in the first trimester
How does the duration of hyperemesis gravidum compare to morning sickness?
Lasts significantly longer
How long does hyperemesis gravidum last?
Symptoms can continue until the give birth, or sometimes after
When is hyperemesis gravidum unlikely to be the cause of vomiting in pregnancy?
If it starts after 12 weeks gestation
What can the differential diagnoses of hyperemesis gravidum be divided into?
- GI causes
- Neurological causes
- UTI
- ENT disease
- Drugs
- Metabolic and endocrine disorders
- Psychological disorders
- Pregnancy associated conditions
What are the GI differentials for hyperemesis gravidum?
- Gastroenteritis
- Cholecysitis
- Peptic ulceration
- Hepatitis
What are the neurological differentials for hyperemesis gravidum?
- Migraine
- Raised ICP
What are the ENT differentials for hyperemesis gravidum?
- Labrynthitis
- Menieres disease
What drugs are differentials for hyperemesis gravidum?
- Opioids
- Iron
What are the metabolic and endocrine differentials for hyperemesis gravidum?
- Hypercalcaemia
- Diabetes
- Addison’s
- Uraemia
- Thyrotoxicosis
What can cause uraemia in pregnancy?
- AKI
- CKD
What are the psychological differentials for hyperemesis gravidum?
Bulimia
What pregnancy associated conditions are differentials for hyperemesis gravidum?
- Pre-eclampsia
- Gestational trophoblastic disease
- Twisted ovarian cyst
- Fatty liver of pregnancy
What investigation should be done in suspected hyperemesis gravidum?
- Renal function and electrolytes
- LFTs
- MIdstream urine for infection and ketones
- Ultrasound to exclude molar or multiple pregnancy
What might the management of hyperemesis gravidum involve?
- Advice
- Fluid and electrolyte replacement
- Nutritional support
- Thiamine supplements
- Anti-emetic medication
- Corticosteroids
What advice should be given in hyperemesis gravidum?
Dietary advice and support
When might IV fluid and electrolyte replacement be required in hyperemesis gravidum?
In women who are severely dehydrated and ketotic
What needs to be done regarding fluid and electrolyte balance in hyperemesis gravidum?
Fluid and electrolyte balance needs to be reassessed often
How is nutritional support given in hyperemesis gravidum?
Can be enteral or parenteral
What are the first-line anti-emetic medications in hyperemesis gravidum?
Promethazine or cyclazine
What are the second-line anti-emetic medications in hyperemesis gravidum?
Metaclopramide or ondansteron
When may corticosteroids be used in hyperemesis gravidum?
For intractable, severe cases
What are the maternal complications of hyperemesis gravidum?
- Weight loss
- Dehydration
- Acidosis
- Hyponatraemia
- Hypokalaemia
- Vitamin deficiency
- Mallory-Weiss tear of oesophagus
- Retinal haemorrhages
- Pneumothorax
How much weight can be lost in hyperemesis gravidum?
10-20% of body weight
What symptoms can hyponatraemia cause?
- Lethargy
- Headache
- Confusion
- Nausea and vomiting
- Seizures
- Respiratory arrest
What can excessive correction of hyponatraemia lead to?
Central pontine myelinolysis
What can hypokalaemia cause?
- Muscle weakness
- Cardiac arrthyhmias
What vitamins may be deficient in hyperemesis gravidum?
- B1
- B12
- B6
What might vitamin B1 deficiency lead to?
Wernicke’s encephalopathy
What might vitamin B12 and B6 deficiency lead to?
- Anaemia
- Peripheral neuropathies
What are the fetal complications of hyperemesis gravidum?
Evidence that it’s associated with higher incidence of lower birth weight (SGA and premature babies)
Is much known about the long-term health outcomes of babies born to mothers with hyperemesis gravidum?
No
