Hyperemesis gravidarum

Hyperemesis gravidarum

1. persistent vomiting in pregnancy

   • weight loss
     • >5% of pre-pregnancy weight
   • ketosis

2. Risk factors

   • multiple pregnancies
   • molar pregnancy
   • previous HG

3. Presentation

   • unable to keep fluid or foods down
   • weight loss +- nutritional def.
   • dehydration
   • hypovolaemia
   • Tachycardia, hypotension
   • electrolyte disturbance
     • hypokalaemia + hyponatraemic shock

4. Investigations

   • Urine dip for ketones + UTI
   • FBC
     • may show raised haematocrit
   • U+E
     • Exclude hypokalaemia or hypoNa
   • LFTs
     • Transaminases may be abnormal, low albumin
   • TFTs
     • often abnormal
   • USS
     • Exclude mole or diagnose multiple preg

5. Management

   • Admit if unable to keep anything down despite oral anti-emetics
     • Aggressively fluid replace with 0.9NaCl + K or Hartmann's
       • Glucose can ppt Wernicke's
       • Anti-emetic regularly eg promethazine, cyclizine or metoclopramide
         • If these methods fail --> try Ondansetron Po/IV
           • Prednisolone or hydrocortisone if vomiting intractable
     • Also prescribe folic acid + thiamine
     • Daily VTE thromboprophylaxis whislt in hospital with enoxaparin + TED