N+V in pregnancy Flashcards
common in which trimester
1st
common in first trimester. usually resolves spontaneously within ….
16-20 weeks
the onset of symptoms after …. weeks gestation usually suggests an alternative cause of symptoms that are unrelated to pregnancy
11 weeks
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?
Onset of symptoms after 11 weeks of gestation usually suggests an alternative cause of symptoms unrelated to pregnancy
You can recommend ginger for mild to moderate nausea or acupressure - true or false
true
2 non pharmacological options
acupressure
ginger for mild to moderate nausea
when to consider antiemetics
persistent symptoms where self care measures e.g. ginger, acupressure, rest, oral hydration ,dietary changes are ineffective
self care advice to give (3)
rest
oral hydration
dietary changes
if you have given an antiemetic, how often should you assess response to treatment
after 24h
if inadequate response, switch to antiemetic from different class
reassess after 24h and if symptoms not settled, specialist
for moderate to severe n+v, consider these adjunct to antiemetic
IV fluids
acupressure
true or false - oral iron or opioids can cause n+v
true
Ask pt about comorbids e.g. DM or CKD as symptoms may increase the risk of complications e.g.
DM - DKA
CKD - AKI
sign of dehydration
reduced or concentration urine output
what is hyperemesis gravidarium
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
HG is characterised by weight loss - usually this much
at least 5% of pre pregnant body weight
management of HG
regular antiemetic therapy, IV fluid and electrolyte replacement
sometimes also nutritional support
for women with severe or persistent HG, may be more appropriate to give non-PO antiemetics e.g. via
rectal or parenteral routes
True or False - consider thiamine supplementation in pt with HG to reduce risk of Wernicke’s encephalopathy
true
RF for n+v in pregnancy (5)
- obesity
- family history of n+v in pregnancy of HG
- Hx HG
- first pregnancy
- increased placental mass - molar gestation, multiple pregnancy
true or false - having twins puts you at increased risk of n+v in pregnancy
true - increased placental mass e.g. molar gestation and multiple pregnancies is a RF for n+v in pregnancy
which of the following is NOT a risk factor of N+V in pregnancy
- obese
- having triplets
- not the first pregnancy
not the first pregnancy.
first pregnancy = risk factor
true or false - possible maternal complication of severe symptoms of n+v can cause GORD and VTE
true
3 possible foetal complications if there is HG
Preterm delivery
Low birthweight
Small-for-gestational age
what is some specific self care advise you can give for mild to moderate symptoms
- 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
