emDocs - June 20, 2016 - Author: Sciano N - Edited by: Koyfman A and Long B
"A woman of reproductive age walks into your Emergency Department with nausea and vomiting. The differential is already broad, but what if she is pregnant? Yes, this may just be “morning sickness”, which can occur in up to 75% of pregnant women. But hey, we’re Emergency Physicians; what else could it be?
We should take into account the whole picture of the patient in front of us including their age, parity, gestational age, body habitus, and ethnicity. If nausea and vomiting have developed after 10 weeks we need to think of non-pregnancy related causes as well. If symptoms occur in the first trimester of pregnancy think of gestational trophoblastic disease (GTD), hyperemesis gravidarum, and multiple gestations. If symptoms occur late in pregnancy our differential should include preeclampsia, HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), and acute fatty liver of pregnancy (AFLP)...
Key Points
- Take into account the whole picture including parity, age, gestational age, and previous pregnancy complications.
- Nausea and vomiting in early pregnancy think molar pregnancy, multiple gestations, and hyperemesis gravidarum.Replete thiamine in hyperemesis.
- Obtain an ultrasound if there is no documentation of one previously.
- Nausea and vomiting late in pregnancy think of HELLP, AFLP, and preeclampsia.
- Check your sixth vital sign: Glucose. This may help differentiate AFLP from HELLP.
- Onset of nausea and vomiting after 10 weeks may be non-pregnancy related.
- Remember “Hypertensive Mom’s Love Nifedipine”
- Magnesium 4-6 grams in 15-20 minutes, followed by maintenance infusion of 1-2 grams/hour."