GULU INSTITUTE OF HEALTH SCIENCES

DCM

OBGYN
• Odongo Denish FOM Gulu University

03/25/2023 ODONGO DENISH FOM Gulu University

 EARLY PREGNANCY NAUSEA & VOMITING
•  Simple – Emesis Gravidarum
• Hyperemesis Gravidarum
• N/v associated with other disorders e.g. Hepatitis, Cholecystitis
and I.O 

SIMPLE – EMESIS GRAVIDARUM.

 AETIOLOGY
• hCG
• Progesterone – relaxes smooth muscle & delays peristalsis
• Pregnancy – pressure effects
• Oestrogen
• Cortisol
03/25/2023 ODONGO DENISH FOM Gulu University
 Rx

• Non-pharmacological.
• Dry breakfast e.g. biscuits before arising from
bed,
• Avoiding spicy foods & fatty foods,
• Avoiding other triggers or precipitants.
• Pharmacological
• Antiemetics

03/25/2023 ODONGO DENISH FOM Gulu University

 HYPEREMESIS GRAVIDARUM

• This syndrome is defined as vomiting

sufficiently pernicious to produce weight loss,
dehydration, acidosis from starvation (ketosis),
alkalosis from loss of hydrochloric acid in
vomitus, and hypokalemia.
• Usually occurs in the first trimester between
weeks 4 &10
•  

03/25/2023 ODONGO DENISH FOM Gulu University

 Associated abnormalities/ complications include

• Abdominal pain
• Ketosis
• Metabolic alkalosis
• Increased haematocrit
• Hypokalemia
• Transient mild hyperthyroidism due to hCG elevation
• Elevated liver enzymes ALT>AST (Transient hepatic
dysfunction)
• Hyperparathyroidism with increased calcium
03/25/2023 ODONGO DENISH FOM Gulu University
 RISK FACTORS
• Nulliparity
• Male foetus
• Multiple gestations
• Familial
• Trophoblastic activity
• Gonadotropin production stimulated
• Altered gastrointestinal function
• Various odors
• Taste or sight of food
• Hyperthyroidism
• Hyperparathyroidism
• Obesity
• Liver dysfunction 
03/25/2023 ODONGO DENISH FOM Gulu University
 PROTECTIVE FACTORS
• Cigarette smoking
• Advanced maternal age. 
CAUSES:
• Unknown
• Hyperthyroidism
• Hyperparathyroidism
• Gestational hormones - Increased serum oestrogen,
progesterone, Hcg
• Liver dysfunction
• Autonomic nervous system dysfunction - Gastric motility
abnormalities
• Psychological factors – somatization, stress
• Micronutrient abnormalities e.g. Zn
03/25/2023 ODONGO DENISH FOM Gulu University
 DIAGNOSIS
• Clinical. Persistent vomiting associated with wt loss >5% of pre-
pregnancy wt 
• SIGNS AND SYMPTOMS: 
• Hypersensitivity to smell
• Alteration in taste
• Nausea
• Vomiting with retching
• Acidosis
• Decreased urine output
• Volume depletion/dehydration
• Fatigue
• Starvation
• wt loss.
03/25/2023 ODONGO DENISH FOM Gulu University
 INVESTIGATIONS

• LFTs
• BP
• Serum electrolytes –
• Urinalysis
• U/S – molar/ multiple gestations
•  
•  

03/25/2023 ODONGO DENISH FOM Gulu University

 Ddx

• GI Disorders e.g. hepatitis, gastroenteritis,

cholecystitis, cholelithiasis, pancreatitis, peptic
ulcer, pyelonephritis, gastritis, reflux oesophagitis
and fatty liver of pregnancy
• Metabolic derangements e.g. from pyelonephritis
• Neurological derangements
• Drug toxicity
• Social & Psychological factors (Anxiety)

03/25/2023 ODONGO DENISH FOM Gulu University

 Rx

• SUPPORTIVE
• Electrolyte replacement
• Rehydration
• Correction of the complications e.g. acidosis,
alkalosis
• DEFINITIVE
• Non-pharmacological
• Dietary changes e.g. CHO, protein
• Avoid triggers/ precipitants
03/25/2023 ODONGO DENISH FOM Gulu University
 Pharmacological

• Pyridoxine 10-25 mg PO TDS

• Promethazine 12.5-25 mg every 4 hours
• Metoclopromide (severe disease)
• Proclorperazine 25 mg rectally every 12 hours are
acceptable second-line agents
• Chlorpromazine
• Parenteral/ Enteral nutrition  
Prevention
• Multivitamins
03/25/2023 ODONGO DENISH FOM Gulu University