Nausea and Vomiting in Pregnancy

Question 1

N&V affects up to what % of pregnant women

Answer 1

90%

Question 2

definition of N&V in pregnancy

Answer 2

N&/V during pregnancy when onset is prior to 16/40 and where there are no other causes

Question 3

when does N&V usually start, peak and resolve by in 90% of women

Answer 3

starts between week 4-7, peaks at 9 weeks, resolves by the 20th week

Question 4

Hyperemesis Gravidarum incidence

Answer 4

between 0.3 and 3.6% of pregnant women

Question 5

Windsor definition of HG

Answer 5

N&V which is severe, starts before 16/40, causing inability to eat and drink normally, strongly limiting daily activities

Question 6

HG recurrence rates

Answer 6

varies from 15.2 - 89%

Question 7

what tools can be used to classify severity of NVP and HG

Answer 7

PUQE dn HELP

Question 8

should ketonuria be used to assess severity

Answer 8

ketonuria is not an indicator of dehydration in pregnancy and should not be used to assess severity

Question 9

aetiology of N&V in pregnancy

Answer 9

hypersensitivity to GD15
GD15 causes loss of appetite, taste aversion, nausea, vomiting, weight los
variation in the GDF15 gene is associated with HG
no genetic variants in hCG have been identified associated with HG - higher circulated GDF15, NOT hCG was found in hospitalised HG patients or those taking medication for NVP

Question 10

in refractory cases of history of previous admissions, what bloods should be added

Answer 10

TFTs and LFTs

Question 11

bloods to do on examination

Answer 11

FBC, U&E, blood glucose, calcium and phosphate, amylase - to exclude pancreatitis