Nausea and vomiting of pregnancy

Question 1

When does nausea and vomiting usually start in pregnancy?

Answer 1

• in first trimester from 4-7 weeks, peaking around 8-12 weeks
• usually resolve by 16-20 weeks

Question 2

What is the severe form of nausea and vomiting in pregnancy called?

Answer 2

Hyperemesis gravidarum

Question 3

What is thought to be responsible for nausea and vomiting during pregnancy?

Answer 3

-placenta producing hCG

Question 4

Describe how nausea and vomiting can differ depending on the type of pregnancy

Answer 4

• more severe in molar and multiple pregnancies due to higher hCG levels
• also tends to be worse in first pregnancy and overweight women

Question 5

How is hyperemesis gravidarum diagnosed?

Answer 5

criteria for diagnosing hyperemesis gravidarum are protracted NVP plus:

• more than 5% weight loss compared with before pregnancy
• dehydration
• electrolyte imbalance

Question 6

How can the severity of NVP be assessed?

Answer 6

using the Pregnancy-Unique Quantification of Emesis (PUQE) score, gives a score out of 15:

• <7=mild
• 7-12=moderate
• > 12=severe

Question 7

What antiemetics can be used to suppress nausea?

Answer 7

• prochlorperazine
• cyclizine
• ondansetron
• metoclopramide

Question 8

How can mild cases of NVP be managed?

Answer 8

-with oral antiemetics at home

Question 9

When should admission be considered for NVP?

Answer 9

• unable to tolerate oral antiemetics and keep down any fluids
• > 5% weight loss compared with pre pregnancy
• urine dipstick shows ketones (+2 or more)
• other medical conditions need treating

Question 10

How can moderate-severe cases of NVP be managed?

Answer 10

may require ambulatory care or admission for:

• IV/IM antiemtics
• IV fluids (saline with KCI)
• daily monitoring of U&Es while having IV therapy
• Thiamine supplementation (prevents wernicke-korsakoff syndrome)
• thromboprophylaxis (TED stocking and LMWH) during admission