Hyperemesis

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Author:
rhondak
ID:
221001
Filename:
Hyperemesis
Updated:
2013-05-24 16:01:39
Tags:
OB
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Description:
HE Grav
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  1. 75% of all women experience N/V. When does it begin and resolve



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    • Begins around 6 weeks
    • Resolves around 16 weeks or 100 days





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  2. Proposed etiology of Hyperemesis (0.3-2%) of population
    • Hormones
    • Progesterone and E2 on GI motility
    • HCG (↑ levels with molar pregnancy)

    • Genetics
    • Increased familial risk
    • Lower risk in Eastern European, highest in India and Sri Lanka
  3. What are the risks of untreated Hyperemesis Gravidarum?
    • Esophageal Rupture
    • retinal hemorrhage
    • renal damage

    • IUGR
    • Fetal Death
    • Voluntary preg termination
  4. Clinical criterion for HE Grav
    • Severe N/V unresponsive to outpat treatment
    • Weight loss >5% prepregnancy wt
    • Ketonuria - get urine dip
    • Abnormal labs - hypokalemia, Metabolic alkalosis ↑ HCT and LFTs
  5. What labs and what reason would you get US in HG
    Labs: Ketones, TSH, lytes, LFTs, Creatinine, mag&phos

    • U/S: to confirm Gestational Age
    • R/O molar pregnancy
    • R/O multifetal gestation
  6. DD for Hyperemesis
    • Hepatitis
    • Pancreatitis
    • Pyelonephritis
    • Bowel obstruction
    • ↑ ICP
  7. What is IVF management for HE Grav
    2 Liters of D5 NS

    • 100mg Thiamine in 1st liter
    • then 100 mg QDX3

    • Gradually ↑ plasma Na
    • 10-12 meq/L day 1, then 18meq total X2days

    Replace K+, Mg, &phos
  8. Medications for HE Grav
    • Benadryl - 1st line therapy
    • Phenothiazines - phenergan
    • Zofran
    • Metoclopramine - Reglan
    • Corticosteroids - severe refractory cases
    • Vitamin B6+Reglan (Pyridoxine)
  9. When is HCG produced
    After blastocyst implantation at 

    23 menstrual days around 8 days after conception
  10. What is the predicable rise in Quantitative HCG
    Doubles q36-48 hrs x10 weeks. Peaks at about  70 days
  11. When does HCG start to decline and what does it get down to?
    Down to 5-20 mIU/mL @ 120 days


    Consider Molar pregnancy with rapid rise
  12. When and what is the peak of HCG?
    at 7-10 weeks HCG rises to 100,000
  13. All products of conception expelled without need for medical or surgical intervention
    Complete Abortion
  14. Only some POC have been passed; Retained products are fetal, placental, or membranes
    Incomplete abortion
  15. Cervix is dilated, but POC are not expelled
    Inevitable abortion
  16. Known fetal demise but no uterine activity to expel POC
    Missed abortion
  17. >3 consecutive pregnancy losses
    Recurrent abortion
  18. Pregnancy complicated by bleeding <20 wks gestation
    Threatened
  19. Spontaneous AB complicated by intrauterine infection
    Septic Abortion
  20. From what is the highest percentage of spontaneous abortions
    49% from random chromosomal anomalies
  21. What are maternal risk factors for SAB



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    • Rapid repeat pregnancy (3-6 mos)
    • IUD use
    • Maternal infection
    • Advanced Maternal Age
    • Substance use/abuse
    • Medications
    • Multiple abortions
    • Anesthetic gas exposure



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  22. 1st TM workup
    • Quant hCG
    • Wet prep (GC & Chlamydia)
    • CBC, Type & Rh
    • US
    • +FHTs
    • Dilated cervix= SAB inevitable

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