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Hyperemesis gravidarum (Clinical
presentation (Persistent, intractible…
Hyperemesis gravidarum
Definition
Excessive vomiting in
pregnancy that causes
5% weight loss, dehydration
and electrolyte imbalances
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Clinical
presentation
Persistent, intractible vomiting
(unable to keep food down)
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Diagnosis
Examination
General: dehydrated, muscle wasting
Abdomen: SFH, tenderness, masses
Investigations
Bedside
Obs (sats, RR, HR, BP, temp)
Bloods
FBC (high Hct), CRP, U+Es (hypo-K, hypo-Na,
metabolic alkalosis), LFTs (low Alb, high ALT)
Imaging
USS foetus: any IUGR, exclude multiple/molar
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History
PGH
Known disorders, menses,
contraception, STIs, smears
PMH
Medical conditions,
previous surgery
POH
Previous HG, conceptions, deliveries,
complications, birth weight
DH
Current meds, allergies
Current pregnancy
Gestation, scans/bloods, foetal movement,
midwife/consultant led, general health
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PC/HPC
Onset, severity, fluid/food,
weight loss, haematemesis
SH
Occupation, smoking, alcohol,
support at home
Management
Medical
IV fluids
Indication: dehydration, can't tolerate PO
E.g. NaCl, Hartman's
NB. avoid glucose solutions as can precipitate Wernicke's
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Antiemetics
Indication: no response to IV fluids
E.g. promethazine (1L), cyclizine
prochlorperazine (2L), ondansetron (3L), steroids (4L)
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Surgical
TOP
Indication: intractible HG, maternal request
MOA: medical or surgical
Conservative
Admit if can't tolerate PO fluids
NBM for 24h then light diet as tolerated
Daily U+Es (electrolytes)
Complications
Maternal
Central pontine myelinosis (hypo-Na and rapid reversal)
Wernicke's encephalopathy (thiamine deficiency)
Liver/renal failure
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