HIPEREMESIS

DEFINITION GRAVIDARUM
Excessive nausea and vomiting in
pregnancy and occur at the beginning of
pregnancy until 20 weeks gestation.
Affects the general condition such as
dehydration, alkalosis, weight loss and
disruptive activity.
 HIPEREMESIS
GRAVIDARUM
EPIDEMIOLOGY

Incidence varies between

populations. there are an estimated
parentage and ethnic predilection.

Frequency of incidence : 2 / 1.000

pregnancies

Hospitalization rates between 0.5%

 HIPEREMESIS
GRAVIDARUM
ETIOLOGY
Unknown
Predisposing factors
In primigravida, who had a mole pregnancy,
multiple pregnancy, diabetes caused high
levels of HCG.
Organic factor, due to the inclusion of vili
chorialis in the maternal circulation and
metabolic changes.
Psychological factors, fear and anxiety, stress.
Endocrine factors.
Allergies, the response from the mother to the
 HIPEREMESIS
GRAVIDARUM
CLASSIFICATION
Grade I Grade II
Nausea, vomitingNausea, vomiting worse
continuously All food regurgitated
Food intolerance Great thirst
Weight loss Pulse 100-140 rpm
Epigastric pain Systolic blood pressure
Increased pulse rate of 100<80mmhg
rpm Oliguria and asetonuria
Systolic blood pressureApathy, pale skin and
dropped jaundice
Skin turgor down Subfebril
Urine slightly but still normal
 HIPEREMESIS
GRAVIDARUM
CLASSIFICATION
Grade III
Disturbances of consciousness (comma)
Cyanosis and jaundice
Cardiac problems
Proteinuria
Increased body temperature
Severe dehydration
Fatal central nervous system: wernicke
encephalopathy
 HIPEREMESIS
GRAVIDARUM
PATHOGENESIS & PATHOPHYSIOLOGY

Increase in pregnancy hormones are high and

fast

Physiological changes such as decreased

gastrointestinal motility and decreased muscle
HCO3- during pregnancy cause symptoms of
nausea

Nausea and vomiting -> dehydration due to

 HIPEREMESIS
GRAVIDARUM
RISK FACTOR

History of previous pregnancy with HEG

Excess weight
Multiple gestation

Trophoblastic disease
Nulliparous
 HIPEREMESIS
GRAVIDARUM
DIAGNOSIS
Anamnesis: amenorrhea, signs of pregnancy,
nausea, vomiting, activities
Physical examination: vital signs, signs of
pregnancy, signs of dehydration
Other examination :
USG to determine the condition of the fetus,
multiple gestation or molar.
Complete hematological laboratory
examination and electrolytes, urinalysis
Psychological consultation
 HIPEREMESIS
GRAVIDARUM
CLINICAL SYMPTOMS
Began to occur in the first trimester
Excessive nausea and vomiting
Weight loss
Ptyalism
Dehydration postural hypotension,
tachycardia
Hyponatremia, hypokalemia
Increased hematocrit
 HIPEREMESIS
GRAVIDARUM
MANAGEMENT
1) NON PHARMACOLOGIC THERAPY
Hospitalization when necessary
Eat in small amounts and frequencies
often
Avoid acidic foods, spicy and too fatty
Adequate fluid
2) PHARMACOLOGIC THERAPY
Giving rehydration with crystalloid fluids
to correct dehydration
Give antiemetic drugs Vit. B6
Glucose infusion
 HIPEREMESIS
GRAVIDARUM
PROGNOSIS

After therapy complaints will be

reduced

Controlled by antiemetic therapy