N/V in Pregnancy

Question 1

N/V in Pregnancy Aetiology

Answer 1

Mostly unknown, in later pregnancies may be from reflux oesophagitis, responds to antacids

Question 2

N/V in Pregnancy Epidemiology

Answer 2

• Affects 90% of pregnant women
• More common in primigravidae, multiple pregnancy, PHx…
• Less common in developing countries

Question 3

N/V in Pregnancy Presentation

Answer 3

• Symptoms start between 4 and 7 weeks of gestation, resolve within 16 weeks in 90% of women
• Check for dehydration and underlying cause
• If symptoms begin after 12 weeks, usually another cause

Question 4

N/V in Pregnancy Differentials

Answer 4

• GI: gastroenteritis, gastritis, cholecystitis, ulcer, hepatitis
• Neuro: migraine, raised ICP
• UTI
• ENT: labyrinthitis, Meniere’s
• Drugs: opioids, iron
• Metabolic/Endocrine: hypercalcaemia, diabetes, Addison’s
• Psychological: bulimia
• Pregnancy associated conditions: pre-eclampsia, gestational trophoblastic disease, twisted ovarian cyst, fatty liver of pregnancy

Question 5

N/V in Pregnancy Ix

Answer 5

• Only required if possible alternative diagnosis
• Not usually required unless concern about mother’s fluid intake
• In hyperemesis gravidarum: renal function and electrolytes, LFTs, midstream urine (infection and ketones), USS (molar/multiple)

Question 6

N/V in Pregnancy Management

Answer 6

• Most cases mild, do not require treatment
• Usually resolves spontaneously within 16-20 weeks
• Dietary suggestions; rest, eat small frequent meals high in carbs low in fat, avoid triggers
• Medication should be avoided but if last resort: metoclopramide for 5 days or odansetron/prochlorperazine
• PPIs and H2 receptor antagonists if dyspepsia
• Admission: continued N/V with ketonuria or weight loss despite antiemetics, inability to keep down anti-emetics, comorbidity
• For fluid electrolyte and vitamin replacement

Question 7

Hyperemesis Gravidarum Definition

Answer 7

Intractable vomiting associated with weight loss of more than 5% of pre-pregnancy weight, dehydration, electrolyte imbalances, ketosis and the need for admission

Question 8

Hyperemesis Gravidarum Epidemiology

Answer 8

• Less than 1% of pregnancies

- More common in hyperthyroidism, psychiatric illness, previous molar, pre-existing diabetes, GI disorders and asthma

Question 9

Hyperemesis Gravidarum Presentation

Answer 9

Vomiting that begins after 12 weeks of gestation unlikely to be hyperemesis gravidarum

Question 10

Hyperemesis Gravidarum Management

Answer 10

• Advice, including dietary advice and support
• Anti emetics as per N/V
• Supportive care
• Thromboprophylaxis: risk of venous thrombosis is increased due to dehydration and immobility, LMWH may be required

Question 11

Hyperemesis Gravidarum Complications

Answer 11

-Weight loss, dehydration, acidosis, hyponatraemia, hypokalaemia, vitamin deficiencies, Mallory-Weiss tears of the oesophagus