Many nonobstetric physicians aren’t well equipped to recognize hyperemesis gravidarum (HG), a debilitating pregnancy complication that can initially appear as garden variety early pregnancy symptoms. The Texas Medical Association has new CME to fill the gap and help physicians craft effective treatment plans.
Kenneth Higby, MD, a consultant on TMA’s Committee on Reproductive, Women’s, and Perinatal Health, helped develop and present the 26-minute webinar, which is worth 0.5 AMA PRA Category 1 Credits™ (enduring) and 0.5 ethics credit.
The New Braunfels obstetrician-gynecologist and maternal and fetal specialist once treated a patient for HG who lost 18 pounds in two to three weeks. That’s typical of the disease, which causes severe nausea and vomiting, often well before a prenatal intake appointment with a physician.
“Most women experience symptoms very early and usually before they have an appointment with their obstetrician. So, they end up going to a clinic or the ER, and those physicians are not well-educated on hyperemesis gravidarum and the concerns for both mother and fetus,” Dr. Higby said.
Risks of the disease include potentially life-threatening electrolyte imbalances and nutritional deficiencies that can require more than simple IV fluids to correct.
The CME’s panel discusses HG screening techniques and evidence-based treatment strategies, including pharmacological and supportive care measures.
The course is a response to recently adopted policy from TMA’s House of Delegates to close the knowledge gap that can impede appropriate treatment of HG, a condition that is distinct from morning sickness and is estimated to affect 1% to 3% of pregnancies. As part of its strategy to enhance physician awareness and education, the association developed the CME, “Awareness and Education for Patients with Hyperemesis Gravidarum,” available on demand in TMA’s Education Center.
To help physicians determine the severity of a patient’s level of HG, the course includes information on a screening tool, the HyperEmesis Level Prediction Score (HELP) Assessment, developed by the Hyperemesis Education and Research (HER) Foundation. A patient’s score on that assessment can then be plugged into an algorithmic flowchart, also created by the HER Foundation and in concert with American College of Obstetricians and Gynecologists guidance, that details treatment options.
Dr. Higby calls the HELP Assessment an important, pertinent tool that has been “well thought out.” Along with Dr. Higby, Robert Emmick, MD, an Austin-based emergency physician, was part of TMA’s workgroup on HG that catalyzed the CME’s development.
“My biggest hope [for it] would be recognition of the need to treat hyperemesis gravidarum more aggressively in the community setting,” said Dr. Emmick, a member of TMA’s Committee on Physician Distribution and Health Care Access.
If a patient hasn’t progressed far enough in their pregnancy to establish care with an OB-gyn yet, “they have nowhere else to turn. And so, they end up in the emergency department.”
Even with the low percentage of pregnant patients who are estimated to experience HG, “it’s not zero,” Dr. Emmick said. “We should strive to help take care of these women. The problem is that it occurs early in pregnancy. So, we need to have a way for women to be able to establish care that is more timely in these situations and recognize the high risk.”
Due to the multifaceted nature of the disease, it can help to enlist a variety of practitioners, Dr. Higby adds.
“We need to do everything we can to increase awareness so we minimize adverse outcomes in both moms and fetuses,” he said. “The more people we get on board, education-wise, the more we can dampen this issue and get a better outcome.”
Find the CME and others in TMA’s Education Center.
Jessica Ridge
Reporter, Division of Communications and Marketing
(512) 370-1395