Hyper-emesis gravidum

Question 1

What is hyper-emesis gravidarum

Answer 1

Inability to keep down fluids or solids -> dehydration, electrolytes and nutrients deficiency

Question 2

Features of hyper-emesis gravidarum

Answer 2

Leading to weight loss (2-5kg)
Electrolyte imbalance
Vit B deficiecny (B6-polyneuropahty, thiamine deficiency - Wernickes encephalopathy)
Rarely - liver failure, renal failure, foetal and maternal mortality
Mallory-Weiss tears of oesophagus and haematemesis

Question 3

Risk factors for hypermesis gravidarum

Answer 3

Higher levels of HCG
Multiple pregnancy
Molar pregnancy
Maternal conditions leading to excessive vomitting
Anorexia nervosa and bulimia
Thyrotoxicosis
Diabetic ketoacidosis
Infections - UTI, GI problems, cholecystisis

Question 4

Investgiations for hyperemsisi gravidum

Answer 4

FBC + clotting + U+Es, haemotocrit, LFTs, thyroid function tests if prolonged
Urine for ketones, culture and sensitivity
USS - multiple pregnancues, molar pregnancies
Social aspects

Question 5

What is PUQE score

Answer 5

For hyperemesis gravidum
Pregnancy unique quantification of emesis

Question 6

Treatment hyperemesis graciaruam

Answer 6

Pregnancy assessment unit if mild
IV fluids
Antiemetics
Small frequent meals
Vitamin B supplementes - thaimain
Social and mental health support
Rarely par-enteral feeding and steroids
Usually termination fo pregnancy is not required and multidisciplinary care with invilvement of psychiatry, gastroenterology, dietician and obs team

Question 7

Symptoms and signs of hyperemsis gravidarum

Question 8

Why does hCG cause hyperemesis graviarum

Answer 8

HCG similarities to TSH as well as receptors –biochemical thyrotoxicosis like condition.

Question 9

Presentation of osmotic demyelination syndrome

Answer 9

Pyramidal tract sighs, spastic quadriparesis
Pseudobulbar palsy and impaired consciousness

Question 10

Wheer is bHCG produced

Answer 10

The chorion

Question 11

What is the chorion

Answer 11

Outside layer of amnitoic sac

Question 12

When do nausea and vomitting noramlly effect pregnancy?

Answer 12

first trimester, peals around 8-12 weeks gestation

Question 13

When is nausea and vomitting normal in pregnancy

Answer 13

normal during early pregnancy. Symptoms usually start from 4 – 7 weeks, are worst around 10 – 12 weeks and resolve by 16 – 20 weeks. Symptoms can persist throughout pregnancy.

Question 14

What causes nausea in pregnancy

Answer 14

hCG released from placenta

Question 15

Which pregnancies is nausea worse in

Answer 15

Molar
Multiple
hCG is higher

Question 16

When is hCG higher?

Answer 16

Molar, multple
Overweigth/obese

Question 16

When is hCG higher?

Answer 16

Molar, multple
Overweigth/obese

Question 17

Diagnosis for hyperemesis gravidarum

Answer 17

> 5% weigth loss vs before pregnancy
Dehydration
Electrolyte imbalance

Question 18

Severity of PUQE

Answer 18

• < 7: Mild
• 7 – 12: Moderate
• > 12: Severe

Question 19

Antiemetics in order of prefernece and known safety in pregnancy

Answer 19

Prochlorperazine
Cyclizine
Ondanestron
Metaclopramide

Question 20

rcog HOW TO manage morning xickness initially

Answer 20

Ranitidine or omeprazole used if acid reflux a problem
Ginger
Acupressure on wrist at PC6

Question 21

Admission for mild hyperemesis gravidarum whne

Answer 21

• 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 + ketones on the urine dipstick is significant)
• Other medical conditions need treating that required admission

Question 22

Moderate-severe cases of hyperemesis gravidarum requriing ambulatory care or admission for:

Answer 22

• IV or IM antiemetics
• IV fluids (normal 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