OBSTETRICS AND GYNECOLOGY■ Ketonemia
■ No abdominal tenderness on exam
DIFFERENTIAL
Includes obstetric and nonobstetric causes of nausea/vomiting such as
pyelonephritis, appendicitis, cholelithiasis, pancreatitis gastroenteritis, and
bowel obstruction
DIAGNOSIS
■ Because nausea and vomiting during pregnancy exist on a continuum,
there is no clear boundary between common morning sickness and hyper-
emesis.
TREATMENT
■ Fluid resuscitation with 5% glucose containing fluids
■ Antiemetics (phenergan, compazine, reglan)
■ Admit patients with persistent vomiting, electrolyte abnormalities, ketosis
despite resuscitation, or weight loss >10% of prepregnancy weight.
■ Consider thiamine (vitamin B1) 100 mg IV for patients with prolonged
symptoms to prevent Wernicke encephalopathy.
NORMAL LABOR AND DELIVERYNormal labor proceeds through three basic stages (see Table 12.2).
FIGURE 12.3. Molar pregnancy with intrauterine “snowstorm” pattern. Serum b-hCG in
this case was >180,000 mIU/mL.
(Courtesy of Robin Marshall, MD as reproduced, with permission, from Knoop KJ, Stack LB,
Storrow AB.Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002:272.)