hyperemesis gravidarum

Question 1

3 risk factors

Answer 1

First pregnancy, young age, multiple pregnancy, molar pregnancy,
hyperthyroidism, previously suffered with motion sickness.

Question 2

most important bedside test and why

Answer 2

Urine dipstick looking for presence of ketones. This suggests
starvation and ketosis.

Question 3

2 blood tests

Answer 3

U&Es (assess kidney function/dehydration), TFTs (assess
hyperthyroid states), LFTs, ABG, FBC.

Question 4

vitamin prescription + other treatments

Answer 4

Thiamine to prevent Wernicke’s encephalopathy.
Low molecular weight heparin, intravenous fluids, anti-emetics,
total parenteral nutrition, steroids.

Question 5

snow storm appearance = cause

Answer 5

Molar pregnancy.

Question 6

when to admit

Answer 6

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

Question 7

triad

Answer 7

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 8

mx

Answer 8

simple measures- avoiding triggers, plain bland food
anti-histamines
oral ondansetron
admission for IV hydration- normal saline w added potassium

Question 9

complications

Answer 9

AKI
Wernicke’s
oesophagitis, mallory weiss
vte