Nausea and Vomiting in Pregnancy

Risk factors for nausea and vomiting of pregnancy are all except

A. History of migraine headaches
B. Helicobacter pylori (H. pylori) infection
C. Corpus luteum present in the right ovary
D. Smoking before pregnancy

Pathogenesis of NVP involves all except

A. Excess of chorionic gonadotropin or higher biological activity of hCG
B. Ovarian hormones, estrogen and progesterone
C. Thyroid-stimulating hormone
D. Placental prostaglandin E2

Hyperemesis gravidarum (HG) can cause all of the pathological changes except

A. Subendocardial hemorrhage
B. Fatty infiltration of liver with necrosis
C. Pneumomediastinum
D. Fatty change in the cells of first convoluted tubule

Biomarkers for HG are all except

A. Ketonuria
B. High TWBC
C. Low urinary chloride
D. Hemodilution

The newly introduced resurgent therapy Diclegis for for nausea and vomiting in pregnancy is a combination of

A. 10 mg doxylamine succinate and 10 mg pyridoxine HCl
B. 10 mg metoclopramide in combination with pyroxamine
C. 8mg Zofran with 10 mg pyridoxine HCl
D. 15 mg Mirtazapine with 10 mg metoclopramide

Which of the following antiemetic is a pregnancy C category drug

A. Metoclopramide
B. Promethazine
C. Ondansetron
D. Doxylamine

In shorts

  • Clonidine, a centrally acting alpha-agonist, is commonly utilized as an antihypertensive agent; however, it has also been referenced in treatment of patients with refractory hyperemesis gravidarum.

  • Metoclopramide is supplied with a “black box” warning of possible irreversible tardive dyskinesia and is absolutely contraindicated in patients who are taking other medications with possible extrapyramidal effects. It is currently rated as pregnancy category B agent.

  • Zofran does not promote gastrointestinal motility and is therefore an agent of choice in cases of emesis and diarrheal symptoms. It is not recommended in cases of nausea where gastroparesis or ileus may be a concern.

  • Mirtazapine has been found to be specifically beneficial in cases of hyperemesis gravidarum compounded by a psychiatric diagnosis such as depression

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