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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Nausea and Vomiting in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
5. Initial Work-up: Physical exam and lab
Hyperemesis gravidarum is a clinical diagnosis, without uniform criteria. As discussed above, one clinical definition is persistent vomiting, with weight loss exceeding 5 percent of pre-pregnancy body weight, and ketonuria.
Nausea and vomiting that develop after 10 weeks of gestation are not likely due to hyperemesis gravidarum. Associated symptoms suggesting other etiologies include abdominal pain and headache. See physical findings and lab abnormalities below.
Physical Exam:
-measurement of weight, orthostatic blood pressures
-fever
-hypertension
-goiter
-abnormal neurologic findings
Lab:
Thyroid function testing
See What about thyroid disease in pregnancy?
Unine
-Ketones
Electrolytes
(hypokalemia is the most common abnormality encountered)
Screen for hepatitis
Serum aminotransferase elevation is usually lower in hyperemesis than in viral
hepatitis. Similarly, serum amylase levels are usually elevated to a lesser degree
than in patients with acute pancreatitis and are of salivary
rather than pancreatic.
Alanine aminotransferase
(ALT, formerly known as SGPT or the serum glutamic pyruvate transaminase)
-usually the most sensitive.
-if it is abnormal, then you can investigate further from there.
If your initial therapy proves unhelpful and the symptoms become worse or evolve, then more of a GI work up may certainly be indicated later.
Ultrasound
An ultrasound examination is performed to exclude molar pregnancy and multiple gestation, both of which are associated with hyperemesis.
