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Hyperemesis gravidarum
Nausea and vomiting occur in 50 ~ 80% of pregnancies in the first trimester. Inability to keep down fluids or solids leads to weight loss (2 to > 5 kg), dehydration, electrolyte disturbances and vitamin B deficiency (polyneuropathy), and may very rarely lead to liver failure, renal failure and fetal or maternal death. (Br J Obstet Gynaecol 1993;8:708).

Check
  1. CBC, Electrolytes, urine for ketones and TFT (see Hyperthyroidism)
  2. LFT and RFT if severe or prolonged (↓albumin, ↑transaminases, PTR normal)
  3. Social aspects of admission.

Treatment
  1. Admission and IV fluids are usually sufficient by themselves to reduce nausea and should be the only initial management.
  2. The patient should eat a little often.
  3. Antiemetics may be used only if the vomiting is not settling. No antiemetics are licensed for use in pregnancy. There is an unquantified, but probably very low, risk of teratogenesis:
    • metoclopramide 10 mg IM/IV TID
    • domperidone 30 mg PO TID
    • chlorpromazine 100 mg suppository QID (may lead to jaundice and extrapyramidal side-effects in the fetus).
    If the vomiting is prolonged, severe and unresponsive to standard management, consider prednisolone 20 mg PO BID or TID or ondansetron 8 mg PO BID. Also consider enteral feeding (or TPN) and vitamin B supplementation. Abnormal LFT respond rapidly to correction of dehydration and malnutrition.

EATING DISORDERS
The incidence of bulimia and anorexia nervosa in pregnancy is less than in the non-pregnant population.
  • Bulimia: Bulimics tend to improve in later pregnancy and often become worse again after delivery. There may be a slightly greater incidence of fetal anomaly.
  • Anorexia nervosa: Anorexics may become worse as pregnancy advances. The incidence of low-birth-weight infants is increased, particularly if ovulation induction has been used to assist conception. The perinatal mortality is also greater. Delay ovulation induction until the weight is >45 kg.
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