Nausea and Vomiting in Pregnancy

Question 1

Morning sickness - What is it?

Answer 1

75% of pregnancy - 1st trimester - can occur at any time of day

Question 2

HG:

What is it?

2 things which HG causes?
- Weight
- Electrolyte

Answer 2

Persistent, severe nausea and vomiting during pregnancy

> 5% of weight loss of pre-pregnancy weight

Ketosis

Guidelines:
>5% WL
Ketosis/electrolyte imbalance
Dehydration

Question 3

HG:

Causes?

Risk factor?

Answer 3

Unknown but thought beta-hCG plays a role

Past history and FH
Increased placental mass:
- multiple pregnancies
- gestational trophoblastic diseases
- trisomy 18/21
Primip/young mum

Question 4

HG - DDx:

• What could be happening later on in pregnancy?
• Other obstetric diseases
• Non-obstetric diseases?

Answer 4

Reflux oesophagitis

PET
Fatty liver of pregnancy

GE
Appendicitis
Raised ICP

Question 5

HG - Presentation:

• THINK OF WHAT WOULD HAPPEN WITHOUT FOOD AND FLUIDS?
• What may happen in the upper GI tract due to persistent vomiting?

Answer 5

Weight loss
Nutritional deficiency
Dehydration
Hypovolaemia - postural hypovolaemia
Tachycardia
Electrolyte disturbance

Haematemesis due to mallory-weiss tear

Question 6

HG - Investigations:

Bedside:
- Urinalysis - why?

Bloods:
- FBC - why?
- U+E - WHY?
- LFT - what does it exclude?

Imaging:
- USS - why?

Answer 6

Raised ketones, excludes UTI as well

WBC - excludes infection

Raised urea
Altered electrolytes potassium + sodium
Excludes liver and pancreatic disease

To diagnose multiple pregnancies
Down’s
GTD

Question 7

HG - Management:

Initial Rx

Why do you not give dextrose?

What can be given to prevent Wernicke’s encephalopathy if vomiting prolonged?

Antiemetics used to relieve N&V but what else can be given IV in severe disease?

Why are they given enoxaparin and stockings?

Answer 7

Admit
Give fluids
Correct any electrolyte imbalances - usually K

It can precipitate Wernicke’s encephalopathy

Thiamine replacement - Pabrinex

Corticosteroids

They have a high risk of having VTE so VTE risk assessed.

Question 8

HG - Management:

Anti-emetics:
- Antihistamines used first.

2 additional options?

Oral tablets usually used for home treatment!

Moderate - severe cases - Ambulatory care (EPAU):

IV anti-emetics + 2 medications?

Answer 8

Prochlorerazine(Stemetil)
Cyclizine

Ondansetron
Metoclopramide

Thiamine supplementation (prevents Wernicke-Korsakoff)

Thromboprophylaxis (Stocking + LMWH)

Question 9

HG - Complications:

Maternal - 3

Fetal - 1

Answer 9

Electrolyte
Vitamin deficiencies - Wernicke’s
Mallory Weiss tear
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IUGR