N/V in pregnancy

Question 1

What are some risk factors of N/V in pregnancy

Answer 1

• Bigger fetus (twins, molar gestation)
• Family history
• Personal history of NVP
• Supertasters
• Migraines
• Lack of MV pre-conception/early pregnancy

Question 2

What is the presentation of Hyperemesis Gravidarum?

Answer 2

• Persistent vomiting not related to other causes
• Measure of acute starvation
• Weight loss
• Electrolyte, thyroid abnormalities

Can be hospitalized during first term

Question 3

What considerations should you have for assessment of N/V?
Nature of symtpoms?
Triggers?
Underlying causes?

Answer 3

Nature of symptoms?
- nausea alone is good enough
- severity, frequency
- look for signs of dehydration

Triggers?
- foods
- odours
- stress

Underlying causes?
- PMH assessments (infection, migraines, malignancy)
- Bowel movements (constipation)
- Changes in drug/ supplement use

Question 4

In the pregnancy-unique quantification of emesis and nausea, what score is considered mild moderate and severe?

Answer 4

Mild: 6 or under
Moderate: 7-12
Severe: 13+

Question 5

What are some non-pharm managements for NVP (4)

Answer 5

1. Diet
   - avoid mixing solids and liquids
   - eat anything whenever and whatever, small meals is fine
2. Fluids:
   - 2L/day
   - Small amounts frequent, cold fluids, popsicles
3. Ginger capsules
4. Rest/sleep

Question 6

What pharmacologic treatment do you give for only nausea?

Answer 6

Pyridoxine 10mg = Vit B6

10-25mg q6-8 hours
Max 200mg/day

Question 7

Explain what to give for step 1 of treatment for N/V.
Drug/class?
Dose?
Counselling?

Answer 7

Doxylamine 10mg/ pyridoxine 10mg
= H1 receptor blocker antihistamine + Vit B6
(Diclectin)
- Delayed release product

Dose:
- 1 tab am, 1 tab afternoon, 2 tabs HS

Counselling:
- Sedation/dizziness
- Take without food: onset = 4-6h
- Take with food: onset: 9-11 hours

Question 8

What is step 2 of treating NVP?
Drug?
Counsel?

Answer 8

Add on H1 receptor antagonists
- Dimenhydrinate (gravol), diphenhydramine, promethazine
- Start with this if symptoms are moderate-severe

Counsel gravol
- Anticholinergic side-effects (sedation, constipation)
- Max: 200mg/day when taking 4 diclectin tabs

Question 9

When do you add on a dopamine antagonist in step 3?
Drugs?

Answer 9

Only if there is no dehydration present
- Prochlorperazine
- Chlorpromazine
- Metoclopramide

Question 10

What is step 4 of treating N/V
Drug + Class?
When to use?

Answer 10

Ondansetron
- Serotonin 5-HT3 receptor antagonist
- Still not approved tho

if they have dehydration

Question 11

What is the last resort for N/V treatment?

Answer 11

Methylprednisolone IV
- 15-20 mg Q8H

Avoid first trimester of pregnancy

Question 12

What are treatments for underlying causes NVP?

Answer 12

GERD/dyspepsia
- calcium carbonate (TUMS)
- H2 blockers (ranitidine)
- Proton pump inhibitors

Gas/bloating
- simethicone, lactase

Treat constipation
- psyllium fibre, stool softeners

Question 13

What vaccinations is recommended in pregnancy

Answer 13

Influenza, Pertussis (whooping cough), Covid 19

Question 14

Explain the zika virus and its effects in pregnancy

Answer 14

Virus transmitted by mosquitoes in high risk areas (avoid travelling)
- Pregnant woman can pass it to fetus
- Causes neurological problems, severe birth defects