Clinical Case Database / Category: Patient Management
Hyperemesis Gravidarum
Publication details
Dr Thirumagal Bavananthan, Mrs Swati Ghosh, Dr Benjamin Miguras
Foundation Years Journal, volume 8, issue 9, p.34 (123Doc Education, London, October 2014)
Abstract
Nausea and vomiting in pregnancy is a common symptom that can cause considerable psychosocial and financial implications but rarely causes morbidity and mortality. This is a common complaint requiring admission in Gynaecology through accident and emergency department and hyperemesis gravidarum is an over-diagnosis in this group. Hyperemesis results in dehydration, metabolic and electrolyte disturbance with increased risk of maternal and fetal morbidity. The pathophysiology is not fully understood but pregnancy hormone fluctuations are thought to play a role. Fluid rehydration and electrolyte replacement with antiemetics are the mainstay of treatment.
The case study described here is a common case scenario encountered by junior doctors. The discussion covers the important aspects in detail which includes history taking, physical examination, differential diagnosis, necessary investigations, management and complications of hyperemesis.
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Authors
Dr Thirumagal Bavananthan
Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB
tbavananthan@hotmail.com
Mrs Swati Ghosh
Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB
swati.ghosh@worcsacute.nhs.uk
Dr Benjamin Miguras
Worcestershire Acute Hospitals NHS Trust
Alexandra Hospital, Woodrow Drive, Redditch, B98 7UB
benjaminmiguras@nhs.net
References
1. Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 9.
2. NICE guidelines on Antenatal Care: routine care for the healthy pregnant woman. CG62, March 2008.
3. Boelig RC, Berghella V, Kelly AJ, Barton SJ, Edwards SJ. Interventions for treating hyperemesis gravidarum. Cochrane Database of Systematic Reviews 2013, Issue 6. Miller F 2002 et al, Nausea and vomiting in pregnancy: the problem of perception--is it really a disease?. American Journal of Obstetrics and Gynecology 2002;186(5 Suppl):S182â€"S183.
4. Neill, A.-M. C. and Nelson-Piercy, C. (2003), Hyperemesis gravidarum. The Obstetrician & Gynaecologist, 5: 204â€"207.
5. Hyperemesis education and research: Potential fetal complications. April 2013. http://www.helpher.org/hyperemesis-gravidarum/complications/fetal-programming.php.
6. Hyperemesis gravidarium - management guideline, Worcestershire Acute Hospital Trust, WAHT-GYN-005, published 07/11/2012.
7. Wood P, Murray A, Sinha B et al. Wernicke's encephalopathy induced by hyperemesis gravidarum.British Journal of Obstetrics and Gynaecology 1983; 90: 583-586.
8. Novak D. et al, Nutrition in early life. How important is it? Clinics in Perinatology 2002 Jun;29(2):203-23.
9. Bolin M et al, Hyperemesis and risks of placental dysfunction disorders, a population-based cohort study, BJOG 2013;120:541â€"547.
10. Subramaniam R et al,Total parenteral nutrition (TPN) and steroid usage in the management of hyperemesis gravidarum. Aust N Z J Obstet Gynaecol 1998;38:339â€"41.
11. Trogstad LI et al, Recurrence risk in hyperemesis gravidarum. BJOG 2005; Dec; 112(12):1641-5.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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