Urgent

Pregnancy, Childbirth, & the Puerperium


{"ops":[{"insert":"Clinical Reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"Decision 1: the probable diagnosis"},{"insert":"\n","attributes":{"header":2}},{"insert":"Priya has presented with nausea and recurrent vomiting for the past 3 days. On examination she is dehydrated. Urine pregnancy testing is positive; and urine dipstick testing show 3+ ketone positivity. \n\nConsidered together, the above combination of findings is suggestive of hyperemesis gravidarum, a common complication of early pregnancy. A molar pregnancy could certainly present similarly\u2014and in fact, Priya\u0027s further investigations need to exclude this possibility. However, this is less common. Ectopic pregnancy is clinically less likely here\u2014affected women typically present with abdominal or pelvic pain and\/or vaginal bleeding.\nDecision 2: inpatient or outpatient management"},{"insert":"\n","attributes":{"header":2}},{"insert":"Many cases of hyperemesis gravidarum can be managed on an outpatient basis. However, Priya\u0027s nausea and vomiting have not responded to oral antiemetics, she is visibly dehydrated, and marked ketonuria is present. Therefore, she is probably best managed as an inpatient.\nDecision 3: the route of rehydration"}]}

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