Nausea and Vomiting of Pregnancy Flashcards
Normal nausea and vomiting in pregnancy
Starts in the first trimester, peaking around 8 – 12 weeks gestation
Hyperemesis gravidarum
Severe nausea and vomiting in pregnancy
When does nausea and vomiting start in pregnancy
4 - 7 weeks
When does nause and vomiting in pregnancy normally resolve
16 - 20 weeks
Why do pregnant ladies get pregnant
Placenta produces beta hCG during pregnancy
Beta HCG can cause nause and vomiting
When is nausea and vomiting more severe
Molar pregnancies
Multiple pregnancies
First pregnancy
Obese women
Criteria for diagnosing hyperemesis gravidarum
Protracted NVP plus:
- More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance
Assessing the Severity of nausea and vomiting
Pregnancy-Unique Quantification of Emesis (PUQE) score. This gives a score out of 15:
< 7: Mild
7 – 12: Moderate
> 12: Severe
Management of nausea and vomiting in pregnancy
Antiemetics
Ranitidine or omeprazole - reflux
Complementary therapies:
- ginger
- Acupressure on the wrist may improve symptoms
Antiemetics
Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide
When should admission be considered for nause and vomiting in pregnancy
Unable to tolerate oral antiemetics or keep down any fluids
More than 5 % weight loss compared with pre-pregnancy
Ketones are present in the urine on a urine dipstick (2 +)
Management of moderate - severe nausea and vomiting in pregnancy
EPAU assessment
Admission for:
- IV or IM antiemetics
- IV fluids (saline with added potassium chloride)
- Daily monitoring of U&Es while having IV therapy
- Thiamine supplementation to prevent deficiency (prevents Wernicke-Korsakoff syndrome)
- Thromboprophylaxis (TED stocking and low molecular weight heparin) during admission
Investigations for nausea and vomiting
Dehydration assessment
Electrolytes
FBC
U+Es
LFTs
Beta HCG
