The Mx of NVP in Pregnancy & HG

At what gestation do the symptoms of NVP typically peak?

• 4 Weeks

• 7 weeks

• 9 weeks

• 12 weeks

• 15 weeks

Answer explanation

NVP typically start between the fourth and seventh weeks of gestation and peaks in 9 weeks and resolves by the 20th week in 90% of women.

In women with hyperemesis gravidarum (HG), abnormal thyroid function tests are

• Raised thyroid antibodies

• Low free thyroxine levels

• Elevated thyroid stimulating hormone (TSH)

• Biochemical hypothyroidism

• Raised free thyroxine levels with or without suppressed TSH

For refractory cases of nausea and vomiting of pregnancy or those with a history of previous admissions, which investigations is not necessary?

• Thyroid function tests

• Calcium and phosphate levels

• Liver function tests

• Amylase levels

• Serum magnesium and zinc

A 21year old, primigravida 9 weeks pregnant is currently admitted for nausea and vomitting.

What antiemetics should be prescribed to her ?

• Prochlorperazine

• Metocloperamide

• Prednisolone

• Veloxin ( Meclozine + Pyridoxine )

Why should dextrose containing solutions be avoided in thiamine deficient states during pregnancy?

• They can cause allergic reactions

• They can precipitate Wernicke encephalopathy

• They may lead to excessive weight gain

• They increase the risk of gestational diabetes

• They interfere with iron absorption

In what case graduated compression stockings be used in pregnant women with HG?

• Always

• Only if they have high blood pressure

• In labour

• When LMWH is contraindicated

What is the recommended thiamine supplementation dose for pregnant women with NVP in pregnancy?

• 100mg orally three times daily or intravenous as part of vitamin b complex like Pabrinex

• 200mg orally three times daily or intravenous as part of vitamin b complex like Pabrinex

• 150mg orally three times daily or intravenous as part of vitamin b complex like Pabrinex

• 50mg orally three times daily or intravenous as part of vitamin b complex like Pabrinex

Which abnormality of acid base balance is most commonly seen in women with NVP?

• Metabolic acidosis

• Metabolic acidosis with respiratory compensation

• Metabolic alkalosis

• Respiratory alkalosis

• Respiratory acidosis

LFT may be deranged in 40% of women with hyperemesis gravidarum. Which component of LFTs is most frequently abnormal?

• Alanine transaminase (ALT)

• Bile acids

• Bilirubin

• Alkaline phosphatase

What is the most appropriate solution for intravenous rehydration in women with NVP?

• 5% dextrose

• Hartmann’s solution

• Human albumin solution 4%

• Normal Saline 0.9%

• Normal Saline 0.9% with potassium chloride