OB- Hyperemesis

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Author:
choward04
ID:
220412
Filename:
OB- Hyperemesis
Updated:
2013-05-20 15:30:58
Tags:
OB
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OB
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  1. When does N/V usually begin and end in pregnancy?
    -Begins ~ 6 weeks and ends ~16 weeks
  2. Discuss Hyperemesis Gravidarum.
    • -Persistant, day & night, severe N/V
    • -Possibly r/t to hormones effect on GI motility
    • -familial risk
  3. What are 4 maternal risk for untreated hyperemesis gravidarum?
    • 1. Esophageal rupture
    • 2. retinal hemorrhage
    • 3. renal damage
    • 4. spont pneumo-mediastum
  4. What are 3 fetal risks associated with hyperemesis gravidum?
    • 1. IUGR
    • 2. fetal death
    • 3. voluntary pregnancy termination
  5. 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)
  6. What 4 abnormal labs might you see?
    • 1. Electrolyte imbalance (hypokal & met alkalosis)
    • 2. Increased HCT (dehydration)
    • 3. Slightly elevated LFTs
    • 4. Mild hyperthyroidism
  7. What labs should you obtain with eval?
    • -ketones
    • -TSH
    • -electrolytes
    • -LFTs
    • -creatinine
    • -magnesium
    • -phosphate
  8. What should be on your DD list for severe N/V?
    • 1. Hepatitis
    • 2. pancreatitis
    • 3. pyelonephritis
    • 4. bowel obstruction
    • 5. hyperthyroidism
    • 6. increased ICP
  9. What should be give along with 2L IVF upon admission?
    -1st L with 100mg thiamine, followed by 100mg QDx 3days
  10. 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
  11. What meds may be given during hyperemesis gravidarum?
    • 1. antihistamines (benadryl 1st line therapy)
    • 2. Phenothiazines (phenergan)
    • 3. Serotonin antagonists (zofran)
    • 4. Metoclopramide
    • 5. Corticosteroids (for severe, refractory)--> cleft palate risk > 10wks
    • 6. Vitamin B6 (pyridoxine) + Reglan more effective than alone
  12. What are 4 suggested meds for mild nausea?
    • 1. Pyroxidine (Vit B6)
    • 2. Doxuylaine (nyquil)
    • 3. Phenergan
    • 4. Dramamine (Dimenhydrinate)
  13. What are meds suggested for persistent N/V with significant dehydration?
    • 1. Reglan
    • 2. zofran
    • 3. Prochlorperazine (compazine)
    • 4. Phenergan
  14. What meds are suggested for severe hyperemesis?
    • 1. Reglan
    • 2. Compazine
    • 3. phenergan
    • 4. zofran
    • 5. Medrol

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