Card Set Information
When does N/V usually begin and end in pregnancy?
-Begins ~ 6 weeks and ends ~16 weeks
Discuss Hyperemesis Gravidarum.
-Persistant, day & night, severe N/V
-Possibly r/t to hormones effect on GI motility
What are 4 maternal risk for untreated hyperemesis gravidarum?
1. Esophageal rupture
2. retinal hemorrhage
3. renal damage
4. spont pneumo-mediastum
What are 3 fetal risks associated with hyperemesis gravidum?
2. fetal death
3. voluntary pregnancy termination
What are the clinical criterion for hyperemesis gravidarum?
1. Severe N/V unresponsive to outpatient management
2. Weight loss -- >5% of pre-pregnancy wt
3. Ketonuria (dipstick)
What 4 abnormal labs might you see?
1. Electrolyte imbalance (hypokal & met alkalosis)
2. Increased HCT (dehydration)
3. Slightly elevated LFTs
4. Mild hyperthyroidism
What labs should you obtain with eval?
What should be on your DD list for severe N/V?
4. bowel obstruction
6. increased ICP
What should be give along with 2L IVF upon admission?
-1st L with 100mg thiamine, followed by 100mg QDx 3days
How much Na should be given upon admision?
On top of the NS-->
-give 10-12meq/L on day 1,
-then 18meq total x 2 days
What meds may be given during hyperemesis gravidarum?
1. antihistamines (benadryl 1st line therapy)
2. Phenothiazines (phenergan)
3. Serotonin antagonists (zofran)
5. Corticosteroids (for severe, refractory)--> cleft palate risk > 10wks
6. Vitamin B6 (pyridoxine) + Reglan more effective than alone
What are 4 suggested meds for mild nausea?
1. Pyroxidine (Vit B6)
2. Doxuylaine (nyquil)
4. Dramamine (Dimenhydrinate)
What are meds suggested for persistent N/V with significant dehydration?
3. Prochlorperazine (compazine)
What meds are suggested for severe hyperemesis?