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Today on the podcast we pick the brain of Dr Matthew Coates, a psychiatrist with experience in perinatal mental health. We talk about the common dilemmas of antidepressant prescribing in pregnancy and how to pick the post-natal patient with genuine mental illness as well as breastfeeding and neonatal issues. We also take a look at the more serious end of the spectrum of psychosis and mania in pregnancy and the post-partum period.
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This week on the podcast we examine the common and very troublesome problem of vomiting in pregnancy, from mild morning sickness to the more severe hyperemesis gravidarum.
Take home messages:
Standard investigations include FBC, UEC, LFT, TFTs, urinalysis and obstetric ultrasoundIn severe cases, consider secondary causes of vomiting such as urosepsis, GI or neurological pathologyDietary advice, ginger and P6 acupressure have mixed evidence but are unlikely to do harmPyridoxine (vitamin B6) and doxylamine have the best evidence for safety and efficacy and should be used first lineSecond line options include metoclopramide, prochlorperazine and promethazine which are all considered safe in early pregnancyIf significant ketonuria, electrolyte imbalance or dehydration, refer for intravenous hydration, parenteral anti-emetics and thiamine
