problems during pregnancy Flashcards
when is hyperemesis gravidarum most common
between 8-12weeks - may persist up to 20
thought to relate to raised beta hCG levels
hyperemesis gravidarm risk factors
increased levels of beta-hCG
- multiple pregnancies
- trophoblastic disease
nulliparity
obesity
family or personal history of N+V in preg
(smoking is assoc with DECREASED incidence of hyperemesis)
when is a admission considered in hyperemesis gravidarum
- N+V + cant keep down liquids or oral antiemetics
- N+V + ketonuria and/or weight loss >5% of body weight, despire treatment with oral antiemetics
- confirmed or suspected comorbidity (eg unable to to take Abx for UTI)
triad of features required for diagnosis of hyperemesis gravidarum
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
scoring system for hyperemesis gravidarum
Pregnancy-unique quantification of emesis (PUQE)
- to classify severity
hyperemesis gravidarum management
simple stuff - rest, avoid triggers, bland plain food, wrist acupressure
1st line meds
- antihist - oral cyclizine, promethazine
- oral prochlorperazine
2nd line
- oral andansetron (risk of cleft palate if use in first tri)
- oral metoclopramide (may cause extrapyramidal SEs, dont use >5days)
which fluids should be used in hyperemesis gravidarum
normal saline with added patassium to rehydrate
complications of hyperemesis gravidarum
- AKI
- wernickes enceph
- oesophagitis, mallory weiss tear
- VTE
fetal
- little evidence of adverse effects
- preterm birth / low birth weight
obstetric cholestasis features
- pruritis - intense, worse on palms, soles and abdomen
jaundice in 20%
raised bilirubin in >90%
recurrence rates of obstetric cholestasis in future pregnancies
45-90%
management of obstetric cholestasis
induction of labour at 37-38wks
ursodeoxycholic acid
vitamin K supplement
complications of obstetric cholestasis
increase risk of premature birth
increase rate of stillbirth
HELLP
haemolysis
elevated liver enzymes
low platelets
acute fatty liver of pregnancy
Acute fatty liver of pregnancy is rare complication which may occur in the third trimester or the period immediately following delivery.
acute fatty liver of pregnancy features
abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia
ALT is typically elevated e.g. 500 u/l
