Nausea and Vomiting of Pregnancy Flashcards Preview

acog 2018 > Nausea and Vomiting of Pregnancy > Flashcards

Flashcards in Nausea and Vomiting of Pregnancy Deck (16):
1

The most commonly cited criteria include persistent vomiting not related to other causes, a measure of acute starvation (usually large ketonuria), and some discrete measure of weight loss, most often at least 5% of prepregnancy weight

ketones in urine
weight loss at least 5%

2

Although biochemical hyperthyroidism may be seen with hyperemesis gravidarum, a palpable goiter is not due to nausea and vomiting of pregnancy. If a goiter is present, primary thyroid disease should be suspected.

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3

subclinical hypothyroidism

HIGH tsh
normal t4, t3

4

hypothyroidism

HIGH tsh
low t3, lowt4

5

subclinical HYPERthyroidism

low tsh
normal t3, normal t4

6

hyperthyroidism

low tsh high/normal t3, t4

7

rare pituitary hypothyroidism

low tsh,
low /normal t3, t4

8

hCG arising from the placenta has been considered a likely candidate for the emetogenic stimulus. The role of hCG also is suggested by the fact that almost all studies of thyroid hormones in pregnancy show an association between transient hyperthyroidism and nausea and vomiting of pregnancy.

hcg --> transient hyperthyroidism

9

Another hormone known to influence nausea and vomiting of pregnancy is estrogen.

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10

Cigarette smoking is associated with lower levels of hCG and estradiol (24), and numerous studies have shown that smokers are less likely to have hyperemesis gravidarum. Estrogen in the combined oral contraceptive pill was shown to induce nausea and vomiting in a dose-related fashion (25). Women with nausea and vomiting after estrogen exposure were more likely to have nausea and vomiting of pregnancy than women who did not demonstrate such sensitivity to estrogen

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11

It also has been posited that nausea and vomiting of pregnancy is an evolutionary adaptation that developed to protect the woman and her fetus from foods that might be potentially dangerous

evolutionary adaptation that developed to protect woman and her fetus from foods that might be potentially dangerous

12

Women with increased placental mass (eg, advanced molar gestation or multiple gestation) are at increased risk of hyperemesis gravidarum

increased placental mass or advanced molar gestation, or multiple gestation are at increased risk of hyperemsis gravidarum

13

Daughters and sisters of women who had hyperemesis gravidarum are more likely to have the same problem, as are women carrying female fetuses

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14

Wernicke encephalopathy (caused by ___deficiency) related to hyperemesis gravidarum has been associated with maternal death or permanent neurologic disability (

vitamin b1 deficiency

15

ginger capsules 250mg 4 times daily

reducing nausea and vomiting

16

vitamin b6 (pyridoxine)10-25 mg orally with doxylamine 12.5mg orally 4 times daily

or
vitamin b6 10mg conbimation, 2 tabs at bedtim initially, up to 4 tabs per day (one in morning and one in midafternoon, and two tablets at bedtime)

b6 total dosage 100mg
doxylamine 50mg total
4 times daily