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Hyperemesis gravidarum — MCCQE Part 1 MCQ

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EasyPregnancyHyperemesis gravidarumMCCQE Part 1

24-year-old woman at 9 weeks' gestation presents with persistent vomiting. She has ketonuria, 4 kg weight loss and mild electrolyte derangement. Which of the following is the most appropriate next step?

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Correct answer: B — Give IV fluids, thiamine before dextrose if prolonged vomiting and pregnancy-safe antiemetics

Give IV fluids, thiamine before dextrose if prolonged vomiting and pregnancy-safe antiemetics is best because weight loss, ketonuria and dehydration indicate hyperemesis gravidarum. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Thiamine reduces Wernicke risk before carbohydrate repletion.

Reference: SOGC nausea and vomiting of pregnancy guideline