Hyperemesis Gravidarum (HG) Flashcards
What type of condition is it?
What is the main risk factor? When does this occur?
What are a few other risk factors for it?
➊ b-hCG related, which is why conditions that increase b-hCG will worsen the HG
➋ Increased placental mass - molar pregnancy, multiple pregnancies
• Due to both increasing b-hCG – Multiple pregnancies is physiological therefore HG isn’t unexpected, but molar pregnancy is pathological and needs to be excluded
➌ • First pregnancy
• Overweight/obese
• Hx or FHx of HG
What is needed for a diagnosis?
What are the diagnostic criteria?
What scoring system is used to assess the severity?
➊ Needs to occur in the 1st trimester (< 12 wks), and other causes need to be excluded first
➋ • Prolonged, persistent, severe N+V unrelated to other causes
‣ If it occurs after 11/12 wks and is less prolonged, other causes like gastroenteritis should be considered
• Weight loss (>5% than pre-pregnancy weight)
• Dehydration and electrolyte imbalance
➌ PUQE’s score
How is it managed?
What is a rare, but important complication here?
N.B. Nothing given orally
➊ * 1st line – Cyclizine, Metoclopramide, Prochlorperazine
* IVF w/Potassium
* Thiamine to prevent Wernicke’s
N.B. An important side-effect to remember for Metoclopramide is acute dystonia (extra-pyramidal side-effect). Due to its antagonism at the D2 receptor, it can also cause block the extra-pyramidal circuits, leading to the side-effects of acute dystonia and tardive dyskinesia. This is same mechanism in which antipsychotics cause their side-effects.
➋ Wernicke’s encephalopathy
