Module 13 - Nausea and Vomiting in Pregnancy Flashcards
NICE,
What proportion of pregnancies are affected by N&V vs HG?
80% N&V
0.3 - 3.6% HG
What is the risk of recurrence of HG?
15 - 80% (depends if self reporting).
But only 10% if a different dad.
When can N&V in pregnancy be diagnosed?
Only in 1st trimester
When is the typical onset of N&V in Pregnancy?
When does this generally peak and resolve?
Onset week 4-7 weeks.
Peak 9 weeks.
90% resolves by 20 weeks.
What stratification can be used for N&V or HG?
PUQE Score
Rhodes Score
What proportion of women with HG will have abnormal TFT’s? (Why?)
66%
bHCG similarity to TSH
What proportion of women with HG will have abnormal LFTs?
40%
Where should women with N&V in pregnancy vs HG be cared for?
N&V in pregnancy - in the community.
HG - Ambulatory care.
Is metoclopromide safe in pregnancy?
Yes,
but there is a risk of extra-pyramidal SEs (including tardative dyskinesia).
This makes it second line.
What proportion of women with N&V will have symptom relief with SC Metoclopromide?
90%
Which anti-emetics have good safety data in pregnancy?
H1 receptor antagonists (cyclizine, promethazine).
Phenothiazines (Prochlorperazine).
Why is ondanstron 2nd line anti-emetic in N&V and HG?
Limited data.
Danish study shows no association, some studies show risk of cleft palate.
What is pyroxidine?
Vit B6
When are cortocosteroids given? What dose is used?
Refractor HG.
100mg IV BD then convert to PO Pred 40-50mg OD and reduce until find maintenance dose.
Why should diazepam not be used?
Although decreases nausea, does not decrease vomiting.
What IVI should be used for rehydration in N&V or HG?
Which should be avoided and why?
NaCL+KcL (guided by daily bloods).
Avoid Dextrose as this can precipitate Weneke’s encephalopathy.
What vitamin supplement should be given to HG women?
Thiamine (B1)
What is the evidence for ginger to be used?
No RCTs for HG.
For N&V:
But better than placebo in N&V.
Equal to B6 and dimenhydrinate.
Less effective than metoclopromide.
What is the evidence for accupuncture and accupressure?
Accupuncture - no evidence.
Accupressure - may improve NVP and some evidence improves HG.
Is gastrodyodenoscpy safe in pregnancy if women develop haemoptysis or severe GI bleeding?
YES
What vitamin should be avoided in NVP/HG patients?
Iron containing preparations as these worsen symptoms.
What is the OR of increased VTE risk for women with HG?
OR 2.5
Define HG
Intractable N&V
>5% weight loss
What are the risks in later pregnancy for women with HG?
IUGR (therefore need growth scans).
<7kg gained in pregnancy, increases risk of PTL (RR3) and decreased birth rate (RR3).
Ketonuria can be monitored to catch symptoms before they start.
What medications are first line for treatment of NVP/HG?
Cyclizine
Prochlorperazine
Promethazine
Chlorpromazine
What medications are 2nd line for NVP/HG?
Metoclopromide
Domperidone
Ondansatron
What PUQE score should prompt EPAU review and ambulatory care?
13+
What is Doxylamine/Pyridoxine (Xonvea)
Delayed release tablet of Doxylamine (100mg antihystamine) and Pyroxidine (10mg vitB6).
When can Doxylamine/Pyridoxine (Xonvea) be used?
Can be used 1st line in pregnancy in women >18 years.
(but released after NICE guideline and GTG published).
What is the evidence for Doxylamine/Pyridoxine (Xonvea)?
Good RCT evidence but only compared to placebo.
Not compared directly to other treatments.
