N&V and hyperemesis gravidarum Flashcards
N&V timeline in pregnancy
usually start 4-7wks
worse around 10-12wks
resolve by 16-20wks
what is thought to be cause of N&V in pregnancy
hCG
higher levels worsen levels e.g. multiple pregnancies, molar pregnancies
hyperemesis gravidarum - criteria for diagnosis
protracted N+V
> 5% weight loss
dehydration
electrolyte imbalance
assessing severity
prenancy-unique quantification of emesis (PUQE) score
< 7 = mild
7-12 = moderate
>12 = severe
choices of antiemetics
prochlorperazine
cyclizine
ondansertron
metclopromide
Mx if acid reflux is problem
ranitidine or omeprazole
Mx Mild cases
oral antiemetics at home
Mild cases - when to consider admission
- unable to tolerate oral antiemetics or keep down any fluids
- > 5% weight loss
- ketones in urine
Mx Mod/Severe cases
Ambulatory care or admisison
- IV/IM antiemetics
- IV fluids
- U&Es monitoring
- thiamine supplements
- VTE prophylaxis in hosp
choice of IV fluid
normal saline + potassium chloride