CASE-1

Zeynep Tuye Çakır

Hatice Taşdemir
Nisanur Duman
Burak Karameşe
Ardıl Demir
Engin Bora Sana
Sena Ak
Mehmet Tuğrul Temel
  Asiye Hanım applied to the Ümraniye Family Health Center for
pregnancy examination.
 She is 17 years old and at the 12. week of her first pregnancy.
 Her pregnancy has been determined by the midwife at the 7th
week during her home visits who asked her to come to the health
center for her first examination.
 Recommendations have been made for appropriate nutrition and
daily activities and asked her to come for the next control after 5
EXAMINATIO weeks.
 After all the controls the examinations have been shown within
N OF CASE the normal levels.
 In the obstetric evaluation other pregnancy fetal heart sounds
have not been heard at the 17th week.
 Pregnant woman has been questioned in detail for the
presence of hyperemesis gravidarum but no complaint had
been detected to support this diagnosis.
 Ultrasonographic evaluation could not be performed in health
center conditions she has been referred to a state hospital.
 Socio-economic and Cultural Background

1 2 3 4
Asiye Hanim was Her husband who Asiye was not Her husband, since he
living with her could not find a job, legally married went to Germany had not
husband’s brother’s went to Germany 1.5 and had no social send her any money and
wife and her three month ago, to work insurance. these two women and
children in the same with his brother who
three children, living
house. was working as a
together in the same house
servant there.
tried to catch their needs
by the help of their
neighbors.
 What do you think for the overall health of Asiye
Hanim and for her pregnancy?
 Why she loose weight? What is Hyperemesis
gravidarum?
 What is the meaning of the absence of fetal heart
sounds?
 What are the social, economic and cultural factors
that could affect Asiye Hanım’s health problem?
 Design a conceptional framework by making
several hypothesis towards these causes.
 17 WEEK
12 WEEK
PREGNANCY
PREGNANCY
HEIGHT: 158 cm HEIGHT: 158 cm
WEIGHT: 50 kg WEIGHT: 47 kg
BODY MASS İNDEX:
BODY MASS INDEX :
20,03
18,83
BLOOD PRESSURE:
110/70 mm Hg BLOOD PRESSURE:
110/60 MM Hg
 What do you think for the health of Asiye Hanim
and for her pregnancy?

Normally, pregnant woman whose body mass

index is between normal levels should gain
11,3-15,8 kg during her pregnancy but our
patient lost 3 kg at 5 weeks
 WHY OUR PATIENT LOST WEIGHT?

Being under stress during Preeclampsia is an A loss of appetite because

pregnancy causes sudden obstetric disease
weight changes and characterized by
frequent weight loss hypertension and high
amounts of protein in the
urine.
of morning sickness can
cause weight loss during
pregnancy

Bad nausea and vomiting preclude Hyperemesis

pregnant woman from eating in a Gravidarium
normal way in first trimester.
Therefore,pregnant women can
weight loss.
HYPEREMESIS GRAVIDARUM
 Hyperemesis gravidarum refers to intractable
vomiting during pregnancy that leads to weight
loss and volume depletion, resulting in
ketonuria or ketonemia.

 There is no consensus on specific diagnostic

criteria, but it generally refers to the severe end
of the spectrum regarding nausea and vomiting
in pregnancy. It can cause a significant impact
on the quality of life of patients and,
unfortunately, may be difficult to treat.
 SYMTOMS TREATMENT
• Feeling nearly constant
nausea • Acupuncture
• Loss of appetite • Hypnosis
• Vomiting more than • Ginger and mint
three or four times per
day • Metaproalimde
• Becoming dehydrated • Promethazine
• Fellinglight-headed or • Vitamin B-6
dizzy
• Losing more than 10 supplement
pounds ( 4.5 kg ) or 5
percent of your body
weight
 On average, pregnant woman should gain
about 1 pound per week of second
trimester, which means that continual
weight loss could be a sign that
something is wrong. However, losing a
pound or two (0,45-0,91 kg) in the
middle of second trimester can be
normal, especially if the person is
experiencing nausea still.

 But, Asiye Hanım lost weight between the

12th and 17th weeks of her pregnancy,
that is in the second trimester. Generally,
the second trimester is the weight gain
trimester as a child grows each week.
 What is the meaning of absence of sound?

Fetal death Anembryonic Baby’s position

pregnancy

Location of placenta Faulty equipment

Growth deficieny Improper technique

What are the social, economic
and cultural factors that could
affect Asiye Hanım’ s health
problem?
Her pregnancy is determined by a
midwife, by traditional methods.
She applied to hospital relatively
late, in the 12th week of her
pregnancy for the first
examination.
She wasn’t informed enough to
detect the problems that can occur
in pregnancy, although she was
losing weight she didn’t go to
hospital until the next
examination.

Economic insecurity was one of

her basic problems, her access to
health care system was restrained
due to lack of her social
insurance.
She didn’t have a stable life,
obscurity could increase the
anxiety level.
She was not able to
consume adequate food
that is essential for a
pregnant woman.
The unknown parameters of her
future , whether her husband is
going to find a job , if they will have
a house on their own, living in a
crowded house and being separate
from her husband could lead to
mental stress.
 HYPOTHESIS
NUTRIENTIONAL DEFICIENCY

The reason for Asiye’s weight loss is due to malnutrition due to economic
problems. She needs help from the social services to take care of herself nd her
baby. Her economic status makes it hard to maintain a healthy diet and
environment.

INSUFFICIENT EQUIPMENT OF PRIMARY HEALTH CARE

The inability to hear the fetal heart sound may be due to the lack of facilities in
the institution that Asiye applied. Primary health care services may be improved.
PSYCOLOGICAL DIFFICULTIES

The job status of Asiye Hanım's husband, the conditions of the house
that she lives in, the financial struggles that she experiences cause her to
have a stressful life, and therefore she loses weight during her pregnancy.
The
stress in her life can be significantly decreased by stablising her life
conditions. This
might help her in recovery of her weight loss and live a healthy pregnancy.
 REFERENCES
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