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Guidelines for the Management of Hyperemesis Gravidarum

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Topics

Treatment (1,5)

Any patient unable to maintain adequate hydration at home should be admitted to the hospital and investigated.

Discontinue any medications that may aggravate symptoms like iron supplements and antibiotics.

Discontinue oral intake.

Maintain input/output chart

IV fluids – N Saline /Hartmans

Fluid and electrolyte regimes should be adapted daily and titrated against the U&E results.

KCL may be added on according to the U & E results

DO NOT USE Double strength saline

Avoid solutions containing dextrose esp if hyponatremia exists.

Antiemetics – Cyclizine 50 mg tds PO/IV/IM
Prochlorperazine – 5-12.5 tds PO/PR/IM
Metoclopramide – 10mg tds PO/IM

Oculogyric crisis may occur – Manage with PROCYCLIIDINE 5 mg IM/IV

Thiamine – Routine supplementation
25 – 50 mg TDS PO if she can tolerate orally
– 100mg in 100ml N Saline infusion over 1 hr weekly.

H2 receptor antagonists – Ranitindine and omeprazole are useful in some patients particularly with associated hematemesis

Thromboprophylaxis – Low Molecular wt Heparin
TED stockings

Corticosteroids – Discuss with Consultant first (3)

Useful in intractable hyperemesis.

  • Hydrocortisone 100mg IV BD
  • followed by 40 mg prednisolone daily.
  • Then maintenance of 5-10 mg daily to continue until symptom amelioration.
  • Screen for diabetes.

Total Parenteral Nutrition – In severe cases.(4)

  • Discuss with consultant first.
  • Psychological support from nursing and medical staff.

Subsequent Management

  • Oral fluids may be re introduced once the symptoms have lessened in severity.
  • Dietary advice
  • Small frequent helpings of food to be taken when symptoms are less severe must be encouraged.
  • Patient may be discharged with oral antiemetics.

References

  1. James et al Evidence based obstetrics 2nd ed 233 -234
  2. Jewell D interventions for nausea and vomiting in pregnancy Cochrane database issue 4
  3. Safari HR Theefficacy of methylprednisolone in the treatment of hyperemesis gravidarum am j obstet gynec 179 921-924
  4. Subramanium R et al TPN and steroids in the management of hyperemesis gravidarum Aust NZJ obst Gynec 1998;39;339- 41
  5. Nelson Piercy Hyperemesis Gravidarum – a review Obst & Gynecol (RCOG UK) vol 5 ; 4 2003


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