Question

How will you manage this lady?

Hint:

Severe vomiting (hyperemesis gravidarum) requires aggressive fluid resuscitation, anti-nausea medication, and careful monitoring for complications like electrolyte imbalances.

Answer 1

Step 1: Initial Assessment and Diagnosis.
After completing the history and examination, the management plan should focus on treating the underlying cause and preventing complications. In this case, the patient is likely experiencing morning sickness or hyperemesis gravidarum.
Step 2: Management of Mild to Moderate Symptoms (Morning Sickness):
- Dietary Modifications: Recommend small, frequent meals and avoiding triggers such as spicy or greasy foods.
- Hydration: Encourage the patient to sip water or oral rehydration solutions to prevent dehydration.
Step 3: Management of Severe Symptoms (Hyperemesis Gravidarum):
If the vomiting is severe and the patient is unable to keep any food or fluids down, the following treatments are considered:
(1) Hospitalization:
- Admit the patient if she shows signs of dehydration or malnutrition. Intravenous fluids (e.g., normal saline with electrolytes) should be administered.
(2) Anti-nausea Medications:
- Pyridoxine (Vitamin B6) is often used first-line, either alone or with doxylamine.
- Ondansetron or metoclopramide can be used for more severe nausea and vomiting.
(3) Electrolyte Correction:
- Correct any electrolyte imbalances (e.g., potassium, magnesium, or sodium).
- Monitor urine output and weight to assess hydration status and nutritional needs.
(4) Nutritional Support:
- In severe cases, parenteral nutrition or enteral feeding may be necessary until the symptoms improve.
Step 4: Follow-up and Long-Term Care.
- Regular follow-up visits to monitor the response to treatment and ensure adequate hydration and nutrition.
- Counsel the patient on the expected course of pregnancy and provide emotional support if necessary.