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Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) -…
Nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG)
Assessment
Pregnancy-Unique Quantification of Emesis and Nausea scored over 24
hours PUQE-24
In the last 24 hours, have you vomited or thrown up?
In the last 24 hours, how long have you felt nauseated or sick to your stomach?
In the last 24 hours, how many times have you had retching or dry heaves without throwing up?
Score
Moderate 7-12
Severe >12
Mild 4-6
Physical exam
consider differential diagnosis
VTE risk assessment
Comprehensive antenatal assessment
Psychosocial assessment
Investigations
Severe NVP or HG
Obstetric ultrasound
Pathology
CMP
LFT
Ketones are not a useful diagnostic marker ( Niemeijer et al)
EUC
Mild/moderate
No further investigations
NVP unresponsive to treatment or signs of thyrotoxicosis
TSH
NVP or HG beyond 16weeks
Fetal growth surveillance in Thrid trimester
Treatment/Care
Pharmacologic
Holistic
Consider dietician (SOMANZ)
Non pharmacological
Acupressure
Diet chagnes (smaller meals more frequently)(SOMANZ)
Rest