Hyperemesis gravidarum: Difference between revisions
| Line 33: | Line 33: | ||
==Management== | ==Management== | ||
===Antiemetics=== | ===Antiemetics=== | ||
''ACOG recommends a stepwise approach to [[nausea and vomiting]] in pregnancy<ref>Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2004; 103:803-815</ref>'' | |||
* | *[[Vitamin B6]] 10-25mg q6-8hrs | ||
* | *ADD [[Doxylamine]] 12.5mg q6-8hrs | ||
* | *ADD [[Promethazine]] 12.5-25mg q4hrs PO or PR | ||
* | *ADD [[Dimenhydrinate]] 50mg q4-6hrs IV OR [[Metoclopramide]] 5-10mg q8hrs IV OR [[Promethazine]] 12.5-25mg q4hrs IV | ||
* | *ADD [[Methylprednisolone]] 16mg q8hrs PO or IV for 3 days and taper to effective dose OR [[ondansteron]] 8mg (or 4mg) q12hrs IV | ||
* | **If using [[ondansetron]], have a discussion about claimed risks of birth defects, and document this due to arising class action lawsuits | ||
{| class="wikitable" | {| class="wikitable" | ||
Revision as of 10:36, 25 October 2015
Background
- Simple nausea and vomiting affects 60-80% of pts during first 12wk of pregnancy
- Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following:
- Wt loss
- Volume depletion
- Hypokalemia
- Ketonemia
Clinical Features
- Signs of volume depletion
- Abdominal pain is highly unusual and if present suggests a different diagnosis
Differential Diagnosis
- Gestational trophoblastic disease (may present with intractable vomiting)
- Thyrotoxicosis (may present with intractable vomiting)
- Biliary disease
- Ectopic pregnancy
- Gastroenteritis
- Pancreatitis
- Appendicitis
- Hepatitis
- Peptic ulcer disease
- Pyelonephritis
- Fatty liver of pregnancy
- HELLP syndrome
Diagnosis
- H&P
- CBC
- Chemistry
- UA
Management
Antiemetics
ACOG recommends a stepwise approach to nausea and vomiting in pregnancy[1]
- Vitamin B6 10-25mg q6-8hrs
- ADD Doxylamine 12.5mg q6-8hrs
- ADD Promethazine 12.5-25mg q4hrs PO or PR
- ADD Dimenhydrinate 50mg q4-6hrs IV OR Metoclopramide 5-10mg q8hrs IV OR Promethazine 12.5-25mg q4hrs IV
- ADD Methylprednisolone 16mg q8hrs PO or IV for 3 days and taper to effective dose OR ondansteron 8mg (or 4mg) q12hrs IV
- If using ondansetron, have a discussion about claimed risks of birth defects, and document this due to arising class action lawsuits
| Medication | Pregnancy Drug Class |
| Vitamin B6 | A |
| Dimenhydrinate | B |
| Doxylamine | B |
| Ondansetron | B |
| Metoclopramide | C |
| Promethazine | C |
Rehydration
- IVF
- Consider fluid with D5 in the setting of ketonuria
Disposition
- Discharge if ketonuria reversed and pt able to tolerate PO
- Admit if:
- Uncertain diagnosis
- Intractable vomiting
- Persistent ketone or electrolyte abnormalities after volume repletion
- Wt loss >10% of prepregnancy weight
References
- ↑ Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2004; 103:803-815