Early pregnancy complications: nausea and vomiting

Question 1

Define nausea, vomiting, retching and hyperemesis gravidarum.

Answer 1

Nausea: Unpleasant painless subjective feeling that one will imminently vomit

Vomiting: Forceful expulsion of gastric contents.

Retching : strong involuntary reverse movements of the stomach and esophagus without vomiting

Hyperemesis gravidarum: Condition of severe, persistent nausea and vomiting during pregnancy ( a diagnosis of exclusion)

Question 2

What is the role of hCG in pregnancy and nausea/vomiting?

Answer 2

CG is produced by the placenta and is made of alpha and beta subunits.

Alpha-subunit is shared with LH, FSH, and TSH; beta-subunit is unique to hCG.

hCG stimulates the chemoreceptor trigger zone → activates vomiting center.

hCG may also stimulate TSH receptors → mimics hyperthyroidism symptoms (e.g., nausea/vomiting).

This condition is called gestational transient thyrotoxicosis (GTT).

No thyroid enlargement or antibodies; resolves by mid-second trimester.

Question 3

Which hormones are associated with nausea and vomiting in pregnancy?

Answer 3

hCG: Main trigger via vomiting center and TSH receptor stimulation.

Estrogen and progesterone: Also contribute to nausea and vomiting.

Symptoms usually improve as hormone levels stabilize in the second trimester.

Question 3

Give 5 risk factors for nausea and vomiting in pregnancy.

Answer 3

• Multiple gestation.
• Molar pregnancy.
• History of other GI problems (e.g. GERD).
• Migraine headache.
• Past history of NV in previous pregnancy.
• Primigravida.
• Psychological stress

Question 4

What are the clinical manifestations of a pregnant woman with nausea and vomiting?

Answer 4

• Prolonged or severe nausea and vomiting
• Hypersalivation
• Signs of dehydration
• Weight loss
• Confusion
• Psychological symptoms

Question 5

Give 5 differentials for nausea and vomiting in pregnancy.

Answer 5

• Hyperemesis gravidarum
• Medications
• Appendicitis
• Infections
  UTI
  Malaria
• Metabolic
  DKA
• Molar pregnancy

Question 6

What is the PUQE score and how is it used in pregnancy?

Answer 6

PUQE (Pregnancy-Unique Quantification of Emesis) score assesses nausea and vomiting severity.

Severity classification: Mild ≤ 6, Moderate = 7–12, Severe = 13–15.

Helps guide treatment decisions and monitor response to therapy

Question 7

How is nausea and vomiting managed in pregnancy?

Answer 7

Out patient management
Diet modifications
Avoid fatty and spicy food
Encourage high protein snacks
Increase intake of carbonated beverages

Alternative therapies:
Tea containing ginger and pyridoxine (Vit B 6)
Oral rehydration

Pharmacological:
oral anti emetics; antihistamines,dopamine receptor antagonists and 5-HT3 receptor antagonists

Question 8

List 5 maternal complications of nausea and vomiting in pregnancy.

Answer 8

• Acute Kidney Injury
• Wernicke’s encephalopathy
• Korsakoff’s encephalopathy
• Mallory Weiss tear
• Hypokalemia
• Miscarriage

Question 9

List 3 fetal complications of nausea and vomiting in pregnancy.

Answer 9

Intrauterine growth restriction
Low birth weight
Preterm birth