Tiêu đề Early Pregnancy ✅

EARLY PREGNANCY NVP / HYPEREMESIS GRAVIDARUM NVP (nausea and vomiting in pregnancy) Defined as the symptom of nausea and/or vomiting during early pregnancy where there are no other causes. HG is the severe form of NVP Hyperemesis Extreme persistent form of Nausea and Vomiting in pregnancy : - Severe, intractable nausea and vomiting - Significant weight loss (>5% of pre-pregnancy weight) - Dehydration - Ketosis - Hypokalemia PP : ↑ serum beta hCG level and elevated thyroxine level (esp a/w high hCG level disease- trophoblastic disease & multiple pregnancy→ ↑ severity) Multifactorial Iman, Izzaty, Nisa, Lissa (18/6/21) Forti
PUQE score Hx Sx - Unable to tolerate any food - Vomiting day & night w/o eating - Thirst - Constipation - Oliguria & concentrated urine - Severe cases: bilious/blood stained vomitus - Wernicke’s encephalopathy (vit B1 def dt starvation) : Drowsiness, blurring vision, nystagmus, loss of vision then coma Quantify severity using PUQE score (check above): nausea, vomiting, hypersalivation, spitting, loss of weight, inability to tolerate food and fluids, effect on quality of life Gestation age PE General dehydration ● Check vitals (temp-slightly rise/pulse-rapid & weak/low BP/SpO2,RR) ● Loss of weight Sx of dehydration ● Sunken eyes ● Dry tongue & mucosa ● Inelastic skin Signs of muscle wasting - prolong starvation • Wasting muscle at temporalis, masseter • Wasting at hypothenar/ thenar muscle Abdominal examination ● Abdominal examination normal Iman, Izzaty, Nisa, Lissa (18/6/21) Forti
- Onset of NVP - first trimester - if the initial onset is after 10+6 weeks -other causes need to be considered. Typically starts between the fourth and seventh weeks of gestation, peaks in approximately the ninth week and resolves by the 20th week in 90% of women Risk Factor - Primigravida - Multiple pregnancy - GTD - Overweight - Previous hx NVP/HG Differential NVP: TRO other causes – abdominal pain – urinary symptoms – infection – drug history – chronic Helicobacter pylori infection Pregnancy related vomiting ● Hyperemesis gravidarum ● Molar pregnancy ● Multiple pregnancy ● Hyperthyroid in pregnancy ● Impending pre-eclampsia ● Fatty liver in pregnancy Non-Pregnancy related GIT ● AGE ● Acute appendicitis ● Peptic ulcer ● Acute cholecystitis ● Acute pancreatitis ● Intestinal obstruction CNS SOL GU - UTI - Acute pyelonephritis ENDO ● Hyperthyroid ● DKA (fam hx DM / previous GDM, polyuria, polydipsia) ● Addidon’s disease ● Uterus larger than date - multiple pregnancy/molar pregnancy ● Uterus smaller than date - pre eclampsia ● Renal punch DIAGNOSIS NVP diagnosed when onset is in the first trimester of pregnancy and other causes of N&V have been excluded Severity for NVP classification : - Pregnancy-Unique Quantification of Emesis (PUQE) score Hyperemesis G diagnosed when there is protracted NVP with the triad of pre pregnancy > 5% weight loss + dehydration + electrolyte imbalance DIAGNOSIS OF EXCLUSION Mostly <10 wks gestation COMPLICATION Mother : - Dehydration - Wernicke’s encephalopathy (Confusion, Ataxia, Opthlamoplegia) dt acute thiamine B1 def - intractable retching predisposes to oesophageal trauma & Mallory–Weiss tears - Elec imbalance & metabolic disturbances→ hypoNA, hypoK, met acidosis - Central Pontine Myelination/Osmotic demyelination syndrome dt severe hypoNA→ spastic quadriplegia & altered consciousness - Peripheral neuropathy & megaloblastic anemia dt pyridoxine vitB6 & cyanocobalamin vitB12 def Iman, Izzaty, Nisa, Lissa (18/6/21) Forti
● Hypercalcemia Drug-induced - thyrotoxicosis BhCG same alpha subunit (molecular mimicry) w TSH→ binds to TSH rec at thyroid glands→ indirectly stimulates thyroid hormones → suppressed TSH To diff HCG & TSH causing ↑ T3/T4 In normal pregnancy, when hCG levels are highest at 10 to 12 weeks gestation- peak HCG levels in normal pregnancy, serum TSH falls and bears a mirror image to the HCG peak. This fall in TSH suggests that it is HCG that causes increased secretion of T3 and T4. - acute kidney injury - liver injury - VTE → pulmonary embolism (unilateral leg swelling, calf tenderness, dyspnea) Fetal : Increased risk of preterm birth,low birth weight babies, IUGR Inadequate nutrition 1. Thiamine (B1) - Wernicke’s encephalopathy -Thiamine critical for glucose metabolism → w/o it glucose metabolized via anaerobic to produce lactic acid → acidosis affecting periventricular structure (thalami, oculomotor nuclei, cerebellar vermis, mammillary body) causes sx as thiamine crosses BBB. -Thiamine def propagate brain tissue injury by inhibiting metabolism in brain 2. HypoNa - Lethargy, seizure, respiratory arrest Iman, Izzaty, Nisa, Lissa (18/6/21) Forti