Hyperemesis gravidarum

Question 1

What is Hyperemesis Gravidarum

Answer 1

It is an unexplained intractable nausea, retching or vomiting beginning in the 1st trimester, resulting in dehydration, ketonuria and typical weight loss of more than 5% of pre pregnancy weight gain.

Question 2

Risk factors

Answer 2

First pregnancy 
Multiple pregnancy 
Obesity 
Prior hx of HG 
Family hx of HG
Trophoblastic disorders 
History of an eating disorder

Question 3

Hormones involved

Answer 3

Estrogen

B hCG

Question 4

Signs and symptoms

Answer 4

Loss of 5% or more of ore pregnancy body weight

Dehydration ( ketosis and constipation)
Nutritional disorders ( vitamin B1,B6 or B12 def)
Metabolic imbalances ( thyrotoxicosis or metabolic keto acidosis)
Physical and emotional stress 

Excessive salivation ( sialorrhea gravidarum)

Question 5

Aggravating factors

Answer 5

Hunger 
Fatigue 
Smells 
Diet 
Prenatal vitamins

Question 6

Investigations

Answer 6

Urine or Blood pregnancy test
Abdomino Pelvic Ultrasound scan
FBC 
EUCr
Urinalysis 
LFT
TFT
Serum amylase

Question 7

Ddx

Answer 7

Gestational tropoblastic disease
Infections: Hepatitis, UTI, gastroenteritis
GI disorders: Appendicitis, Gastroparesis,cholecystitis,Pancreatitis,fatty liver, PUD
Drug toxicity
Metabolic disorders

Question 8

First line treatment

Answer 8

Dry bland food and oral rehydration

Question 9

Pharmacological treatment

Answer 9

Antiemetics

Pyridoxine
Doxylamine
Metoclopramide

Question 10

Complications

Answer 10

Dehydration 
Hyponatremia 
Hypoglycemia 
Malnutrition 
Kidney failure 
Anemia 
Coagulopathy 
Wernicke’s encephalopathy ( thiamine def)