Managing Hyperemesis Gravidarum: Symptoms, Diagnosis, and Treatment
A 30-year-old woman expecting twins presents with severe vomiting at 11 weeks gestation. Learn about signs of hyperemesis gravidarum, potential differentials, a scoring system for severity, management strategies, associated complications, and the uncertain etiology. Explore NICE and RCOG guidelines on nausea and vomiting in pregnancy along with a historical fact related to HG's impact.
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Presentation Transcript
30-year-old G2P1 woman with twin pregnancy at 11 weeks presents with severe vomiting Sarah Perrott, Created 12/08/21 Tag Year: Year 3 Tag specialty: Reproduction
Introduction You are working in A&E Julie, a 30-year-old gravida 2 para 1, presents to A&E with severe vomiting. She is at 11 weeks gestation and is expecting twins. She has had severe nausea and vomiting for 24 hours. In her previous pregnancy she also suffered from morning sickness . On examination, Julie is afebrile, respiratory rate 14 breaths/minute, pulse 105 bpm, blood pressure 121/84.
Question 1 What signs and symptoms of hyperemesis gravidarum would you look for/ask about?
Question 2 Name some potential differentials and list the tests/investigations which would be appropriate to help identify the cause.
Julie has dry mucous membranes and has lost 4kg since her weight was last recorded 4 weeks ago. Question 3 What scoring system can be used to quantify hyperemesis severity?
Question 4 Outline the management of HG.
Aetiology of HG is unclear, thought to be combination of several factors
Question 5 What complications are associated with HG?
Useful resources Nausea and vomiting in pregnancy NICE guidelines https://cks.nice.org.uk/topics/nausea-vomiting-in-pregnancy/ Nausea and vomiting in pregnancy and hyperemesis gravidarum RCOG guidelines https://www.rcog.org.uk/globalassets/documents/guidelines/green-top- guidelines/gtg69-hyperemesis.pdf Fun fact: HG was the cause of death of Charlotte Bronte; her two sisters (Anne and Emily) died of tuberculosis.
