Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Nausea and Vomiting in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
4. Initial Work-up: History
Case Scenario
Mrs. H is a 30 y/o G3P2 at 9 weeks by her dates who presents for her first prenatal visit complaining of nausea with vomiting that lasts pretty much all day, but she is able to keep some food down. She says this has occurred with each of her pregnancies, but this time it is especially troublesome. She has had a small amount of spotting but no cramping. She appears to be well hydrated.
Your initial work up at this time should include?
Hyperemesis is generally a diagnosis of exclusion, based on its occurrence in pregnancy before 10 weeks of gestation and likely gradual resolution
A simple basic workup is helpful and might include:
History: Anything to suggest:
Gastrointestinal problems?
-gastroenteritis, hepatitis, pancreatitis, cholelithiasis, ulcer
-colicy RUQ pain radiating to the shoulder for gallbladder disease, epigastric pain and pyrosis for peptic ulcer disease, a history of ethanol ingestion, etc….
Metabolic problems?
-diabetes, porphyria
Neurologic disease?
-migraine, tumor, vestibular lesions
Pregnancy related?
(typically in the latter half of pregnancy)
-Preeclampsia
-HELLP syndrome (Hemolysis,
Elevated Liver function tests, Low Platelets)
-Acute
fatty liver of pregnancy
Other
Drug toxicity, genitourinary tract disorders, and psychological problems
Nausea and vomiting that develop after 10 weeks of gestation are not likely due to hyperemesis gravidarum.
Associated symptoms suggesting
other etiologies
discussed above include abdominal pain, fever, headache,
goiter, abnormal; neurologic findings, or hypertension.
Acrobat
MS Word
