Nausea + Vomiting in Pregnancy/ Hyperemesis Gravidarum
Nausea and Vomitting in pregnancy
Epidemiology
• affects 50-90% of pregnant women
• often limited to T1 but may persist
Management
dietary and lifestyle:
- frequent small meals
- increase fluid intake
- stop prenatal vitamins (folic acid must continue until >12 wks), increase sleep/rest
• pharmacological: pyroxidine (Vit B6) -> prochlorperazine -> promethazine ->metoclopramide
• alternative therapies: ginger, acupuncture, acupressure
• severe/refractory: consider homecare with IV fluids and parenteral anti-emetics, hospitalization
Source
Toronto notes 2012
• affects 50-90% of pregnant women
• often limited to T1 but may persist
Management
dietary and lifestyle:
- frequent small meals
- increase fluid intake
- stop prenatal vitamins (folic acid must continue until >12 wks), increase sleep/rest
• pharmacological: pyroxidine (Vit B6) -> prochlorperazine -> promethazine ->metoclopramide
• alternative therapies: ginger, acupuncture, acupressure
• severe/refractory: consider homecare with IV fluids and parenteral anti-emetics, hospitalization
Source
Toronto notes 2012
Hyperemesis Gravidarum
Definition
Excessive vomiting common in T1 and can persist over whole pregnancy.
Occures in 1/1000
>5% loss of body weight
Aetiology
Believed to be caused by pregnancy hormones
Clinical Features
Signs of dehydration (2 vitals: ++HR, --BP, 2 hard: --JVP, --urine output, 2 soft: -- skin turgor, dry mucosa)
Weight loss
Haemetemesis (from Mallory Weiss tear)
Investigations
Bedside: Urinalysis (check ketones), MSU (exclude UTI)
Bloods: FBC, U&E, LFT (reduced albumin)
Imaging: USS to check for molar pregnancy
Management
Admit if not tolerating oral fluids
· IV fluids+Electrolyte replenishment+ Thiamine (50mg tds)/(100mg IV weekly infusion)
· Daily U&E
· NBM if vomiting excessively
· If no response to IV and electrolyte replacement consider promethazine/ cyclizine 50mg/8hr PO/IM/IV 1st line
· Termination in the event of intractable severe hyperemesis gravidarum
Complications
· Electrolyte Imbalance
· Thiamine deficiency-> Werneicke’s Encephalopathy-> Fetal Death
· IUGR
Source
Oxford handbook of Obstetrics and Gynaecology 3 edition
Excessive vomiting common in T1 and can persist over whole pregnancy.
Occures in 1/1000
>5% loss of body weight
Aetiology
Believed to be caused by pregnancy hormones
Clinical Features
Signs of dehydration (2 vitals: ++HR, --BP, 2 hard: --JVP, --urine output, 2 soft: -- skin turgor, dry mucosa)
Weight loss
Haemetemesis (from Mallory Weiss tear)
Investigations
Bedside: Urinalysis (check ketones), MSU (exclude UTI)
Bloods: FBC, U&E, LFT (reduced albumin)
Imaging: USS to check for molar pregnancy
Management
Admit if not tolerating oral fluids
· IV fluids+Electrolyte replenishment+ Thiamine (50mg tds)/(100mg IV weekly infusion)
· Daily U&E
· NBM if vomiting excessively
· If no response to IV and electrolyte replacement consider promethazine/ cyclizine 50mg/8hr PO/IM/IV 1st line
· Termination in the event of intractable severe hyperemesis gravidarum
Complications
· Electrolyte Imbalance
· Thiamine deficiency-> Werneicke’s Encephalopathy-> Fetal Death
· IUGR
Source
Oxford handbook of Obstetrics and Gynaecology 3 edition