HG

Question 1

Nausea and vomiting in pregnancy definition

Answer 1

N, V and or/dry retching caused by pregnancy, with symptoms commencing in the first trimester

Severity assessed by the PUQE-24 system

Question 2

PUQE 24 questions

Answer 2

Nausea in last 24 hours (times)
How many times thrown up
How many times retched or dry heaved

Question 3

HG

Answer 3

N and or vomiting causes by pregnancy leading to significant reduction of oral intake and weight loss of at least 5% compared to pre pregnancy, with or without dehydration and/or electrolyte abnormality

Question 4

Investigations of those with HG

Answer 4

Na, K, Cl, Bicarbonate, Mg, urea, cr
Biko, ALT, AST, albumin
USS
TSH

Question 5

Inpatient management required if:

Answer 5

Severe electrolyte disturbance
Significant renal impairment or AKI
Concurrent significant co-morbidity (T1DM)

Question 6

Other therapies to use in HG

Answer 6

Thiamine
Treatment of GORD
LMWH
Avoid iron if this exacerbates symptoms

Question 7

Antiemetic agents

Answer 7

First line: cyclizine, proclorperazine (10mg), promethazine (25md), chlorpromazine

Second line: metoclopramide, dompiridone, ondansetron

Third line: corticosteroids (hydrocortisone 100mg twice daily IV, then convert to prednisone 40-50mg daily once clinically improve and aim to taper)

Fourth line: mirtazepine