N&V and hyperemesis gravidarum

Question 1

N&V timeline in pregnancy

Answer 1

usually start 4-7wks
worse around 10-12wks
resolve by 16-20wks

Question 2

what is thought to be cause of N&V in pregnancy

Answer 2

hCG

higher levels worsen levels e.g. multiple pregnancies, molar pregnancies

Question 3

hyperemesis gravidarum - criteria for diagnosis

Answer 3

protracted N+V
> 5% weight loss
dehydration
electrolyte imbalance

Question 4

assessing severity

Answer 4

prenancy-unique quantification of emesis (PUQE) score

< 7 = mild
7-12 = moderate
>12 = severe

Question 5

choices of antiemetics

Answer 5

prochlorperazine
cyclizine
ondansertron
metclopromide

Question 6

Mx if acid reflux is problem

Answer 6

ranitidine or omeprazole

Question 7

Mx Mild cases

Answer 7

oral antiemetics at home

Question 8

Mild cases - when to consider admission

Answer 8

• unable to tolerate oral antiemetics or keep down any fluids
• > 5% weight loss
• ketones in urine

Question 9

Mx Mod/Severe cases

Answer 9

Ambulatory care or admisison

• IV/IM antiemetics
• IV fluids
• U&Es monitoring
• thiamine supplements
• VTE prophylaxis in hosp

Question 10

choice of IV fluid

Answer 10

normal saline + potassium chloride