Hyperemesis

Question 1

List the potential maternal complications of moderate/severe hyperemesis:

Answer 1

a. Dehydration
b. VTE: DVT or PE
c. Electrolyte imbalance: hyponatremia, metabolic hypochloraemic alkalosis
d. AKI /renal impairment
e. Malnutrition: Wernickes Korsakoff encephalopathy
f. Fetal: demise, growth restriction
g. Psychological / depression
GORD / gastritis / oesphagitis / Mallory Weiss tear

Question 2

Define hyperemesis gravidarum:

Answer 2

• Nausea and vomiting in pregnancy
• > 5% weight loss
• Dehydration
• Electrolyte imbalance

Question 3

List causes/risk factors for hyperemesis:

Answer 3

• High levels of hCG or specific isoforms e.g. molar, multiple pregnancy.
• Hyperthyroidism
• Female fetus
• H pylori infection
• Trace element deficiency
• Psychiatric
• Cyclic-vomiting syndrome

Question 4

List differential diagnoses for hyperemesis:

Answer 4

a. Pregnancy-related: multiple pregnancy, molar pregnancy
b. GU: UTI/pyelo
c. GI: infectious gastroenteritis, GORD/H pylori
d. Endocrine: hyperthyroidism, hyperparathyroidism causing hypercalcaemia, DKA, Addison’s disease
e. Surgical: bowel obstruction, peptic ulcer, cholecystitis, pancreatitis.
f. Drug-related: iron, antibiotics, marjiuana (cyclical vomiting).
g. CNS: migraine, raised ICP

Question 5

Outline the management principles for hyperemesis:

Answer 5

a. Reduce N&V
b. Manage associated GI dysmotility (reflux, constipation)
c. Maintenance of hydration, fluid and electrolyte replacement
d. Nutrition and vitamin supplementation
e. Psychosocial support
f. Monitoring and prevention of side effect and adverse pregnancy and fetal outcomes

Question 6

What are two complementary management options for hyperemsis?

Answer 6

a. Ginger up to 1200mg/day in split dose e.g. 250 mg QID

b. Acupressure wrist bands (poor) and accupuncture