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afsha - nausea and labyrinth disorders > N+V in pregnancy > Flashcards

N+V in pregnancy Flashcards

1
Q

common in which trimester

A

1st

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2
Q

common in first trimester. usually resolves spontaneously within ….

A

16-20 weeks

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3
Q

the onset of symptoms after …. weeks gestation usually suggests an alternative cause of symptoms that are unrelated to pregnancy

A

11 weeks

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4
Q

a patient presents with nausea and vomiting after 11 weeks gestation. is this normal pregnancy sickness, or does it suggest an alternative cause of symptoms unrelated to pregnancy?

A

Onset of symptoms after 11 weeks of gestation usually suggests an alternative cause of symptoms unrelated to pregnancy

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5
Q

You can recommend ginger for mild to moderate nausea or acupressure - true or false

A

true

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6
Q

2 non pharmacological options

A

acupressure
ginger for mild to moderate nausea

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7
Q

when to consider antiemetics

A

persistent symptoms where self care measures e.g. ginger, acupressure, rest, oral hydration ,dietary changes are ineffective

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8
Q

self care advice to give (3)

A

rest
oral hydration
dietary changes

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9
Q

if you have given an antiemetic, how often should you assess response to treatment

A

after 24h
if inadequate response, switch to antiemetic from different class
reassess after 24h and if symptoms not settled, specialist

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10
Q

for moderate to severe n+v, consider these adjunct to antiemetic

A

IV fluids
acupressure

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11
Q

true or false - oral iron or opioids can cause n+v

A

true

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12
Q

Ask pt about comorbids e.g. DM or CKD as symptoms may increase the risk of complications e.g.

A

DM - DKA
CKD - AKI

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13
Q

sign of dehydration

A

reduced or concentration urine output

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14
Q

what is hyperemesis gravidarium

A

more serious condition
characterised by prolonged, persistent and severe n+v unrelated to other causes, weight loss (usually at least 5% of pre pregnant body weight) and dehydration & electrolyte imbalance

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15
Q

HG is characterised by weight loss - usually this much

A

at least 5% of pre pregnant body weight

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16
Q

management of HG

A

regular antiemetic therapy, IV fluid and electrolyte replacement
sometimes also nutritional support

17
Q

for women with severe or persistent HG, may be more appropriate to give non-PO antiemetics e.g. via

A

rectal or parenteral routes

18
Q

True or False - consider thiamine supplementation in pt with HG to reduce risk of Wernicke’s encephalopathy

A

true

19
Q

RF for n+v in pregnancy (5)

A
  • obesity
  • family history of n+v in pregnancy of HG
  • Hx HG
  • first pregnancy
  • increased placental mass - molar gestation, multiple pregnancy
20
Q

true or false - having twins puts you at increased risk of n+v in pregnancy

A

true - increased placental mass e.g. molar gestation and multiple pregnancies is a RF for n+v in pregnancy

21
Q

which of the following is NOT a risk factor of N+V in pregnancy
- obese
- having triplets
- not the first pregnancy

A

not the first pregnancy.
first pregnancy = risk factor

22
Q

true or false - possible maternal complication of severe symptoms of n+v can cause GORD and VTE

A

true

23
Q

3 possible foetal complications if there is HG

A

Preterm delivery
Low birthweight
Small-for-gestational age

24
Q

what is some specific self care advise you can give for mild to moderate symptoms

A
  • rest as needed
  • avoid triggering sensory stimuli e.g. odours, heat, noise
  • eat plain biscuits or crackers in morning
  • eat bland, small, frequent, protein rich meals that are low in carbs and fat
  • cold meals may be more easily tolerated in nausea is smell related
  • drink little and often, not large amounts
  • ginger - fresh, tea, caps or syrup form
  • acupressure e.g. over P6 point on ventral aspect of wrist using wrist band or finger pressure
25
Q

true or false - if n+v is related to smell, it may be best to take cold meals

A

true

26
Q

where would you recommend acupressure

A

over P6 point on ventral aspect of wrist using a wrist band or finger pressure

27
Q

advice on avoiding meals that may contribute to symptoms

A

iron containing preps depending on clinical judgement

28
Q

if a pt has had n+v in pregnancy, what would you say about future pregnancies

A

early use of lifestyle measures and antiemetics before or immediately at start of symptoms may be helpful

29
Q

1st line antiemetics for n+v (3 options) + reviews

A

oral cyclizine or promethazine (antihistamines)
prochlorperazine or chlorpromazine (phenothiazines)
Xonvea: doxylamine/pyridoxine

reassess after 24h.
if responsive, continue and review pt once a week thereafter depending on clinical judgement

30
Q

if 1st line option is ineffective, give these 2nd line

+ review and what to do if ineffective

A

switch to 2nd line antiemetic from a different drug class and reassess after 24h e.g.
- dopamine receptor antagonists e.g. metoclopramide, domperidone
- 5HT3 antagonist e.g. ondansetron

is responsive, continue and review pt once a week thereafter, depending on clinical judgement
if ineffective, specialist advice

31
Q

max duration of use metoclopramide and domperidone

A

m: max 5 days, risk of neurological extrapyrimadol SE
d: max 7 days, risk of cardiac adverse effects

32
Q

max duration of use ondansetron and in pregnancy

A

max 5 days
1st trimester: small increased risk of cleft lip/palate

33
Q

which antiemetic holds a small increased risk of cleft lip/palate if used in first trimester

A

ondansetron

34
Q

Review the need for ongoing treatment and advice on gradually reducing and stopping meds when symptoms improve, depending on clinical judgement

A
  • may be possible to stop at around 12-16 weeks when symptoms have usually improved
  • gradually tapering dose may reduce risk of symptoms recurring
35
Q

when to arrange admission or referral

A
  • persistent moderate to severe n+v and
  • suspected HF despite oral antiemetics
  • suspected severe or serious complication
  • symptoms not controlled with management in primary care
  • unable to tolerate all antiemetics or oral fluids
  • unable to tolerate other necessary oral drug treatments e.g. abx for UTI or usual meds for comorbid conditions
36
Q

true or false - have a lower threshold for admitting pt to hospital to seeking specialist advice if the woman has comorbids e.g. DM which may be adversely affected by symptoms

A

true

afsha - nausea and labyrinth disorders (8 decks)

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