Hyperemesis Gravidarum

Question 1

What percentage of women get hyperemesis gravidarum?

Answer 1

1%

Question 2

What causes the excessive vomiting?

Answer 2

Raised beta hCG levels.

Question 3

In what weeks of pregnancy does hyperemesis gravidarum occur at?

Answer 3

8 to 12 weeks.

(But may persist up to 20 week)

Question 4

What conditions are associated with Hyperemesis Gravidarum?

Answer 4

• Multiple pregnancies
• Trophoblastic disease
• Hyperthyroidism
• Mulliparity
• Obesity

Question 5

What is associated with a decreased incidence of hyperemesis?

Answer 5

Smoking

Question 6

What are some complications of hyperemesis gravidarum?

Answer 6

• Wernicke’s encephalopathy
• Mallory-Weiss tear
• Central pontine myelinolysis
• Acute tubular necrosis
• Fetal: small for gestational age, pre-term birth

Question 7

How do you manage hyperemesis gravidarum?

Answer 7

1. First line - Promethiazine first line
2. Second line - Metoclopramide or Prochlorperazine.
   
   • Can give stat Prochlorperazine (Phenergan) (12.5mg IM)
3. Ginger and P6 (wrist) acupressure. (little evidence but NICE suggests you can try.)
4. Admission as may need IV Fluids.

Question 8

What should be considered to prevent Wernicke’s Encephalopathy?

Answer 8

Thiamine supplements