Nausea & Vomiting in Pregnancy. Ashley Robbins, MD, FACOG Associate Clinical Professor, KUSM-W

Transcription

1 Nausea & Vomiting in Pregnancy Ashley Robbins, MD, FACOG Associate Clinical Professor, KUSM-W

2 Nausea and Vomiting in Pregnancy Prevalence of nausea in pregnancy 50-80% Prevalence of vomiting and retching in pregnancy 50% Early treatment can prevent progression to Hyperemesis Gravidarum 0.3-3% of pregnancies 2 nd most common reason for hospitalization in pregnancy

3 Pregnancy-Unique Quantification of Emesis and Nausea (PUQE)

4 Hyperemesis Gravidarum Persistent vomiting not related to other causes Measure of acute starvation Discrete measure of weight loss

5 Gestational Transient Thyrotoxicosis Limited to the first ½ of pregnancy Suppressed TSH with increased ft4 Treat with supportive therapy

6 Etiologies Hormonal Stimulus Evolutionary Adaptation Psychologic Predisposition

7 Nonpharmacologic Therapies Prenatal Vitamins 1 mo prior to pregnancy Frequent small meals Ginger

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12 Cannabis for Morning Sickness? Not supported by ACOG or AAP!

13 Cannabis Hyperemesis Syndrome Occurs with chronic use of high-potency marijuana Abdominal pain, nausea, vomiting Relieved with hot showers IVF, antiemetics, benzodiazepines

14 Which of the following assessments are included in the modified pregnancy-unique quantification of emesis and nausea (PUQE) score? a. How long do you feel nauseated or sick to your stomach? b. How many times do you vomit or throw up? c. How many times do you have retching or dry heaves without bringing anything up? d. All of these assessments are part of the PUQE score.

15 Which of the following assessments are included in the modified pregnancy-unique quantification of emesis and nausea (PUQE) score? a. How long do you feel nauseated or sick to your stomach? b. How many times do you vomit or throw up? c. How many times do you have retching or dry heaves without bringing anything up? d. All of these assessments are part of the PUQE score.

16 Which factor is suggested as a potential etiology for nausea and vomiting of pregnancy? a. Low levels of human chorionic gonadotropin b. Low levels of estradiol c. High levels of human chorionic gonadotropin or estradiol. d. Response to an inherited genetic predisposition.

17 Which factor is suggested as a potential etiology for nausea and vomiting of pregnancy? a. Low levels of human chorionic gonadotropin b. Low levels of estradiol c. High levels of human chorionic gonadotropin or estradiol. d. Response to an inherited genetic predisposition.

18 A 19-year-old G1P0 woman at 7 weeks gestation is diagnosed with hyperemesis gravidarum. Thyroidfunction tests demonstrate an elevated free T4 and suppressed serum thyroid stimulating hormone (TSH). Which of the following is considered appropriate management of the hyperemesis gravidarum? a. Supportive therapy such as antiemetic and hydration therapy b. Antithyroid medications such as levothyroxine c. Antithyroid medications such as propylthiouracil (PTU) d. Consultation with an endocrinologist

19 A 19-year-old G1P0 woman at 7 weeks gestation is diagnosed with hyperemesis gravidarum. Thyroidfunction tests demonstrate an elevated free T4 and suppressed serum thyroid stimulating hormone (TSH). Which of the following is considered appropriate management of the hyperemesis gravidarum? a. Supportive therapy such as antiemetic and hydration therapy b. Antithyroid medications such as levothyroxine c. Antithyroid medications such as propylthiouracil (PTU) d. Consultation with an endocrinologist

20 A 23-year-old G1P0 woman with hyperemesis gravidarum is concerned about the effects this may have on her pregnancy. You tell her: a. Her pregnancy is at an incrased risk of miscarriage. b. Her pregnancy is at an increased risk of congenital anomalies. c. The presence of hyperemesis gravidarum often means well for pregnancy outcome. d. Her pregnancy is at an increased risk of perinatal and neonatal mortality.

21 A 23-year-old G1P0 woman with hyperemesis gravidarum is concerned about the effects this may have on her pregnancy. You tell her: a. Her pregnancy is at an incrased risk of miscarriage. b. Her pregnancy is at an increased risk of congenital anomalies. c. The presence of hyperemesis gravidarum often means well for pregnancy outcome. d. Her pregnancy is at an increased risk of perinatal and neonatal mortality.

22 Thank you!