hyperemysis Flashcards
(19 cards)
What is hyperemesis gravidarum?
A severe form of nausea and vomiting during pregnancy that can lead to complications if untreated
Occurs in approximately 3% of pregnancies and affects overall wellbeing.
What percentage of pregnant individuals experience nausea and vomiting?
50-80%
This statistic highlights the commonality of nausea and vomiting during pregnancy.
What are the clinical features of hyperemesis gravidarum?
Characterized by severe protracted nausea and vomiting, appetite loss, dehydration, and electrolyte imbalances
Symptoms typically occur between 5-6 weeks of gestation.
What is the recommended first-line anti-emetic for hyperemesis gravidarum?
Metoclopramide
It is safe to use throughout pregnancy and has no evidence of adverse harm to the fetus.
What is the role of antihistamines in treating hyperemesis gravidarum?
They act on histamine receptors and the vestibular system to decrease stimulation of the vomiting center
Commonly used antihistamines include promethazine and cyclizine.
What is the dosing for cyclizine?
25–50mg eight-hourly oral/IV
It is a piperazine antihistamine with no observed increase in malformation risk when used in the first trimester.
What is prochlorperazine classified as?
A dopamine antagonist
It works by blocking dopamine 2 receptors involved in emetic signaling.
What are some risk factors for hyperemesis gravidarum?
- Previous affected pregnancy
- Family history
- Hyperthyroidism
- Pregestational diabetes
- High BMI prior to pregnancy
- Multiple pregnancy
- Nulliparity
These factors increase the likelihood of developing hyperemesis gravidarum.
What protective factors are associated with hyperemesis gravidarum?
- Older than 30 years
- Taking multivitamins
These factors may reduce the risk of hyperemesis gravidarum.
What laboratory findings can indicate hyperemesis gravidarum?
- Hyponatraemia
- Hypokalaemia
- Low serum urea
- Metabolic hypochloraemic alkalosis
- Ketonuria
- Raised haematocrit level
- Increased specific gravity of urine
- Abnormal liver function tests
These tests help confirm the diagnosis and assess severity.
What is the physiological impact of hyperemesis gravidarum?
Inhibited GI motility, increased bowel transit times, and hormonal influences from HCG and estrogen
These factors contribute to the symptoms of nausea and vomiting.
What is the significance of thiamine in managing hyperemesis gravidarum?
It is given to prevent Wernicke’s encephalopathy due to prolonged vomiting
Thiamine supplementation is crucial for anyone with severe vomiting.
What is the role of corticosteroids in hyperemesis gravidarum?
They may be used in severe refractory cases
Caution is advised due to potential side effects.
What are the options for enteral feeding in hyperemesis gravidarum?
- Nasogastric (NG) tubes
- Nasoduodenal tubes
- Nasojejunal tubes
- Percutaneous endoscopic gastrostomy or jejunostomy feeding
Enteral feeding is considered if patients do not respond to standard treatment.
What is the most important component of management for hyperemesis gravidarum?
Adequate fluid and electrolyte replacement
Normal saline and potassium chloride are commonly used.
True or False: Common anti-emetics are teratogenic.
False
Most common anti-emetics are not associated with teratogenic effects.
What is the diagnosis of hyperemesis gravidarum based on?
A diagnosis of exclusion, ruling out other causes of nausea and vomiting
This includes infections, endocrine disorders, and medication reactions.
What maternal complications can arise from untreated hyperemesis gravidarum?
- Severe morbidity
- Mortality
- Wernicke’s encephalopathy
Vitamin B deficiency can lead to serious neurological symptoms.
What fetal complications may result from hyperemesis gravidarum?
- Small for gestational age (SGA)
- Fetal death
Particularly linked to untreated cases and Wernicke’s encephalopathy.
