Preface

Nausea and vomiting occurred in 50-90% of pregnancy. In a study of 360 pregnant women
2% have nausea and vomit just in the morning 80% of them lasting for the whole day.

Preface(2)
If it troubles your acticity and causing complication then we call this hiperemsis gravidarum.
Ketonuria Dehidration Hipokalemia Weight loss >3kg or 5% of weight

Preface(3)
25% percent of hiperemesis patient was treated in ward Some caused depression and idea of terminating the pregnancy

Definition
According to The Norwegian Society of Gynecology and Obstetrics (NFOG), hiperemesis gravidarum is nausea and vomiting that occurred before 20 weeks of gestation age and this condition persist, it cause dehidration, weight loss, fluid and electrolyte.

 Usually hiperemesis symptom emerge in ealry first trisemester 4th to 10th week. The peak symptom raise starting from 8 weeks to maximum at 12 weeks and resolved at 20 weeks of gestation.

 Hiperemesis gravidarum were categorized to there stage

Stage 1
Endless vomiting timbul toleransi terhadap makanan dan minuman berat badan menurun nyeri epigastrium muntah pertama keluar makanan, lendir dan sedikit cairan empedu dan yang terakhir keluar darah Nadi meningkat hingga 100 kali per menit dan tekanan darah sistolik menurun Mata cekung dan lidah kering, turgor kulit berkurang dan urin sedikit tetapi masih dalam batas normal.

 Stage 2
Gejala yang timbul lebih berat daripada derajat I semua yang dimakan dan diminum dimuntahkan kembali oleh pasien rasa haus yang hebat sub-febril nadi cepat dan lebih dari 100-140 kali per menit tekanan darah sitolik kurang dari 80 mmHg apatis, kulit pucat, lidah kotor, kadang ikterus, terdapat aseton dan bilirubin dalam urin serta berat badan yang cepat menurun.

 Stage 3
Hiperemesis gravidarum tingkat III sangat jarang terjadi Keadaan ini merupakan kelanjutan dari hiperemesis gravidarum tingkat II yang ditandai dengan muntah yang berkurang atau bahkan berhenti tetapi kesadaran pasien menurun (delirium sampai koma) Pasien dapat mengalami ikterus, sianosis, nistagmus, gangguan jantung dan dalam urin ditemukan bilirubin dan protein

Risk Factor
Moms factor
Age and obstetric history Body Mass Index (BMI) History of past illness

Babys factor
Male or female? Twin pregnancy Mola Hidatidosa Range of pregnancy

Conclusion
Hiperemesis gravidarum occurred in 0.5-2% pregnancy in the world. hiperemesis gravidarum is nausea and vomiting that occurred before 20 weeks of gestation age and this condition persist, it cause dehidration, weight loss, fluid and electrolyte.

 Usually hiperemesis symptom emerge in ealry first trisemester 4th to 10th week. The peak symptom raise starting from 8 weeks to maximum at 12 weeks and resolved at 20 weeks of gestation.

 Hiperemesis can be triggered by some of these hormones

Estrogen Progesterone ACTH Kortisol Growth Hormone Prolactin

 The most common symptomp found is nausea and vomiting that lasting for the whole day. Hiperemesis gravidarum can cause fluid and electrolyte imbalance. The most important therepy is parenteral fluid delivery and electrolyte corection.

 Hiperemesis gravidarum can cause complication to mother and baby.

Electrolyte imbalance Nutrition deficit Weight loss