Hyperemesis gravidarum

Question 1

Define hyperemesis gravidarum.

Answer 1

Excessive vomiting in early pregnancy associated with ketosis and dehydration.

Question 2

Explain the aetiology of hyperemesis gravidarum.

Answer 2

Poorly understood but associated with BHCG levels.

Question 3

What are the risk factors for hyperemesis gravidarum?

Answer 3

Multiple pregnancy, GTD, previous HG, high BMI, nulliparity, low maternal age, hyperthyorid

Question 4

Summarise the epidemiology of hyperemesis gravidarum.

Answer 4

1% pregnant women.

Question 5

Recognise the presenting symptoms of hyperemesis gravidarum.

Answer 5

Severe N&V

Anorexia

Weight loss

Question 6

Recognise the signs of hyperemesis gravidarum on physical examination.

Answer 6

Dehydration

Tachycardia

Hypotension

Dry mucous membranes.

Question 7

Identify appropriate investigations for hyperemesis gravidarum and interpret the results.

Answer 7

Utine: Assess ketosis, exclude UTI

Bloods: FBC, BHCG, U&Es, LFT, TFT.

USS to exclude multiple and GTD.

Question 8

Generate a management plan for hyperemesis gravidarum.

Answer 8

Admit, rehydrate with IV saline or Hartmann’s. NOT dextrose.

PO thiamine, consider thromboprophylaxis.

Severe – prednigolone, total parenteral nutrition.

Question 9

Identify the possible complications of hyperemesis gravidarum and its management. Summarise the prognosis for patients with hyperemesis gravidarum.

Answer 9

MW tears, Wernickes encephalopathy from loss of B1, muscle wasting, VTE from dehydration, electrolyte disturbance, renal impairment.

Good prognosis with treatment.