Hyperemesis gravidarum
| By definition: | 1. Onset before 20 weeks gestation 2. Ketosis 3. Weight loss >5% of pre-pregnancy weight |
|---|---|
| Etiology | N+V in pregnancy affects up to 90% of pregnant patients (miserable), but 90% resolve by 20/40. Caused by ↑HCG. |
| Epidemiology | Risk factors: multiple pregnancy, molar pregnancy |
| Clinical presentation | PUQE - standardised assessment of severity Ddx: UTI |
| Diagnostic investigations | U+E, glucose, urine dip |
| Management | NB all antiemetics are unlicensed - Conservative: PO fluids, small frequent protein-rich/low-fat meals, ginger - Primary care measures not tolerated + PUQE < 13: ambulatory day care for parenteral fluids, nutrition - Antiemetics: ➥ 1st line: PO cyclizine, promethazine, prochlorperazine ➥ 2nd line: PO metoclopramide (max 5 days), domperidone ➥ Ondansetron = small risk of cleft lip/palate ➥ 3rd line: prednisolone 40-50mg → tapering dose to minimum dose required to control nausea; will need glucose monitoring - IV fluids: NaCl + KCl guided by daily electrolytes; no dextrose ⚠ Wernicke’s encephalopathy! Thiamine, VTE prophylaxis - PPI? - Stop Fe supplements if they worsen N&V Complications: Mallory-Weiss tears, dehydration and associated electrolyte problems e.g. hypokalaemia etc., Wernicke's encephalopathy |
| Discharge advice | - Risk recurrence in future pregnancies - Advise monitoring for AKI, haematemesis, unstoppable vomiting, inability to eat/drink for 24h |