HYPEREMESIS

GRAVIDARUM

PREPARED BY:-
Mr. ARKAB KHAN PATHAN
 INTRODUCTION:-

HYPER : EXCESSIVE
 EMESIS : VOMIT
 GRAVIDARUM : PREGNANCY

Nausea/vomit of moderate intensity are

especially common until about 16 week.
 HEG occurs when vomiting becomes
intractable in early pregnancy & cause fluid &
electrolyte imbalances & nutritional deficiency.
 women usually needs to be hospitalized.
 DEFINITION:
“HG IS DEFINED VARIABLY AS VOMITING
SUFFICIENTLY SEVERE TO PRODUCE WEIGHT
LOSS, DEHYDRATION, ACIDOSIS FROM
STARVATION, ALKALOSIS FROM LOSS OF HCL IN
VOMIT & HYPOKALAMIA.”

“SEVERE VOMITING IN PREGNANCY

PERTICULARLY DURING EARLY PREGNANCY
CAUSING DELETERIOUS AFFECTION MOTHER’S
HEALTH SUCH AS WEIGHT LOSS,
DEHYDRATION, ACIDOSIS OCCURS FROM
STARVATION.”
 ETIOLOGY:-

 Unknown
 More common in-
o Trophoblastic disease
o Multiple pregnancy
o Nuliperity
o Female fetus
o Age > 30year
o Maternal obesity
o Smoking
o Those who had HEG in previous pregnancy
o Has got familial history
 THEORIES:-

HORMONAL THEORY :

excess of HCG & estrogen trigger vomiting

centre

progesterone excess relaxation of cardiac

sphincter retension of gestric fluid.

PSYCHOGENIC THEORY:
IT PROBABLY AGGRAVATED NAUSEA TRIGGER
NEUROGENIC ELEMENTS SOMETIMES TRIGGER
DIETARY DEFICIENCY:
Due to low CHO reserve deficiency of vitamin B1,
B6 & protein may be the effect rather than cause.

ALLERGIC OR IMMUNOLOGICAL BASIS

DECREASE GASTRIC MOTILITY

ANY PATHOLOGY OF :
LIVER
KIDNEY
HEART
BRAIN
 TYPES:
HEG

EARLY LATE

VOMITING
THROUGHOUT EVIDANCE OF
DAY DEHYDRATION
NO EVIDANCE & STARVATIO
OF PRESENT
DEHYDRATION
& STARVATION
 CLINICAL FEATURE:-

 SYMPTOM

• Excess vomiting & retching day & night.

• Vomiting initially watery & bilious.(Weight loss seen)
• Oliguria
• Seldom mental symptoms
• EPIGESTRIC pain
• Constipation
• Ptyalism
• Spitting
• Fatigue
• Anorexia
 CLINICAL FEATURE:-
 SIGN:

• Dehydration
•Muscle wasting
•Ketosis
•Weight loss > 5% of pregnancy weight
•Tachycardia
•Postural hypotension
•Dry coated tongue
•Sunken eyes
•Acetone smell in breath
 INVESTIGATION:

a) URIN ANALYSIS
b) CBC
c) LIVER FUNCTION TEST(LFT)
d) THYROID FUNCTION TEST
e) ULTRASOUND SCAN
f) OPHTHELMOSCOPY
 MANAGEMENT

 Principles of management:-

 To control vomiting.
 To correct fluid & electrolyte imbalance.
 To correct metabolic disturbance.
 To prevent serious complications of severe
vomiting.
 MEDICAL MANAGEMENT:

DRUGS:

Antiemetic:-
Promethazin 25mg IM bd or tds
Trifluopromazine 10mg IM
Metachlopromide 10mg IM

Hydrocortisone:- 100mg IV in drip

Pridnisolone orally
Nutritional support:-
Vitamin B1, vitamin B6, vitamin B12 & vitamin C
 FLUID:

• 3 ltr 5% dextrose & RL infusion in 24 hrs.

• K+ supplement fluid .

 NURSING MANAGEMENT:-
 Initiate measures to alleviate nausea including
medication therapy. If unsuccessfully on weight
loss & electrolyte imbalances occur, IV
administration of fluid & electrolyte replacement
or total parenteral nutrition may be necessary.
 Monitor lab data & for sign of dehydration &
electrolyte imbalances.
NURSING MANAGEMENT

 Monitor urine for ketone.

 Monitor fetal heart rate, fetal activity & fetal growth.
 Encourage intake of small proportion of food.
 Liquid should be taken b/w meals to avoid distending
stomach & triggering vomit.
 Encourage patient to sit upright after meal.
 OBSTETRIC CARE:

 No therapeutic abortion is indicated if patient improve on

therapy.
 Therapeutic abortion is seldom indicated on-
o Vomiting doesn’t abote on therapy
o if there is risk of complication.
 COMPLICATIONS

 Dehydration
 electrolyte imbalance
 renal failure

 Wernicke’s Encephalopathy
(Thiamine deficiency)

 Vitamin K deficiency : maternal

coaggulopathy or fetal intracranial
hemorrhage
 COMPLICATIONS

Mallory Weiss tears

Characterized by upper gastro-intestinal
bleeding secondary to longitudinal mucosal
lacerations at the gastroesophageal junction
or gastric cardia.
 COMPLICATIONS

 Boerhaave syndrome -
characterized by upper gastrointestinal bleeding
secondary to transmural perforation of the
esophagus
 MANAGEMENT OF NAUSE AND VOMITING
SYMPTOM:

o Drink & eat little & often.

o Meal high in CHO & low in fat is better.
o Cold meals reduce smell related nausea.
o Avoid caffeine & alcohol as these can
enhancer dehydration.