What are the guideline sources, guidelines and references for Hyperemesis gravidarum ?
Guideline sources The following summarized guidelines for the evaluation and management of hyperemesis gravidarum (HG) are prepared by our editorial team based on guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG 2019). 1 Calculator Pregnancy Unique-Quantificatio Guidelines 1. Screening and diagnosis Diagnosis: diagnose HG if protracted NVOP is present with the triad of > 5% pre-pregnancy weight loss, dehydration and electrolyte imbalance. B https://web.pathway.md/diseases/recw71AkdMBOlT6MB 1/4 6/24/23, 12:45 PM Hyperemesis gravidarum Pathway Differential diagnosis: elicit clinical history, perform focused examination and investigations to exclude other pathological causes. B 2. Classification and risk stratification Severity grading: consider using an objective and validated index of nausea and vomiting such as the PUQE score to classify the severity of NVOP. C 3. Diagnostic investigations Initial evaluation: be aware of the features in history, examination and investigation assisting in the assessment, diagnosing and monitoring of the severity of HG. B 4. Medical management Setting of care: Consider managing patients in an inpatient setting if 1 of the following present: continued nausea and vomiting and inability to keep down oral antiemetics continued nausea and vomiting associated with ketonuria and/or weight loss (> 5% of body weight), despite oral antiemetics confirmed or suspected comorbidities, such as UTI and inability to tolerate oral antibiotics. C Multidisciplinary management: consider involving other professionals, such as midwives, nurses, dietitians, pharmacists, endocrinologists, nutritionists and gastroenterologists, and a mental health team, including a psychiatrist, in the care of patients with HG. C Antiemetics: offer antiemetics such as H1RAs and phenothiazines as first-line therapy in patients with HG. B Show 6 more Rehydration therapy: use normal saline with additional potassium chloride in each bag, with administration guided by daily monitoring of electrolytes, for IV hydration in patients with HG. B Show 2 more Corticosteroids: reserve corticosteroids for cases where standard therapies have failed. A Diazepam: do not use diazepam for the management of patients with HG. D Acid-reducing agents: consider offering H2RAs or PPIs in patients with HG developing GERD, esophagitis or gastritis. C Thromboprophylaxis: offer thromboprophylaxis with LMWH in patients admitted with HG, unless there are specific contraindications such as active bleeding. Consider discontinuing thromboprophylaxis upon discharge. B 5. Nonpharmacologic interventions https://web.pathway.md/diseases/recw71AkdMBOlT6MB 2/4 6/24/23, 12:45 PM Hyperemesis gravidarum Pathway Nutrition: consider offering enteral or parenteral treatment with a multidisciplinary approach when all other medical therapies have failed. C Supplements: offer thiamine supplements (either PO or IV) in all patients admitted with prolonged vomiting, especially before administration of dextrose or parenteral nutrition. B Show 2 more Acupuncture: consider reassuring patients that acustimulations are safe in pregnancy. C Hypnosis: do not offer hypnotic therapies for the management of patients with HG. D Psychosocial care: address the severity of symptoms in relation to the patient's quality of life and social situation, as the quality of life can be adversely affected by HG. B Show 3 more Rest: advise patients to rest as required to alleviate symptoms. B 6. Therapeutic procedures Termination of pregnancy: attempt all therapeutic measures before offering termination of a wanted pregnancy. B 7. Follow-up and surveillance Follow-up: Prepare an individualized management plan for patients with HG when they are discharged from hospital. B Offer serial scans to monitor fetal growth in patients with HG experiencing continued symptoms into the late second or the third trimester. B Future pregnancies: Inform patients with previous HG that there is a risk of recurrence in future pregnancies. B Advise early use of lifestyle/dietary modifications and antiemetics that were found to be useful in the index pregnancy to reduce the risk of HG in the current pregnancy. B References 1. Ioannis Tsakiridis, Apostolos Mamopoulos, Apostolos Athanasiadis et al. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum. Obstet Gynecol Surv. 2019 Mar;74 3 161 169. Open 2. Tram T Tran, Joseph Ahn, Nancy S Reau. ACG Clinical Guideline: Liver Disease and Pregnancy. Am J Gastroenterol. 2016 Feb;111 2 176 94; quiz 196. Open 3. Italian Association for the Study of the Liver AISF , Italian Association for the Study of the Liver AISF. AISF position paper on liver disease and pregnancy. Dig Liver Dis. 2016 Feb;48 2 120 37. Open https://web.pathway.md/diseases/recw71AkdMBOlT6MB 3/4 6/24/23, 12:45 PM Hyperemesis gravidarum Pathway 4. Monika Sarkar, Carla W Brady, Jaquelyn Fleckenstein et al. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73 1 318 365. Open https://web.pathway.md/diseases/recw71AkdMBOlT6MB 4/4