HYPEREMESIS GRAVIDARUM
Dr.Sunanda
DEFINITION ETIOLOGY PATHOLOGY CLINICAL FEATURES INVESTIGATIONS COMPLICATIONS MANAGEMENT
DEFINITION Severe type of vomiting of pregnancy which has
got deleterious effect on the health of the mother &/or incapacitates her in day to day activities.
ETIOLOGY Hormonal- 1. higher HCG level- twins, GTT2. higher oestrogen level3. progesterone excess -relaxation of cardiac sphincter & impaired
gastric motility Dietary deficiency-low carbohydrate intake, vit B6,B1
deficiency Psychogenic Genetic Allergic or immunological basis Liver dysfunction Vestibular system dysfunction
PATHOLOGY Metabolic changes- Glycogen depletion- incomplete oxidation of fat-
ketone bodies Biochemical- plasma K, Na, Cl. acidosis, ketosis, blood urea, uric acid Circulatory- haemoconcentration- rise in Hb,RBC count,
haematocrit
CLINICAL COURSE Early-no evidence of dehydration or starvation
Late-evidence of dehydration or starvation
Features of dehydration and ketoacidosis-• dry coated tongue,• sunken eyes,• acetone smell in the breath • tachycardia,• hypotension• Rise in temperature,• Jaundice
INVESTIGATIONS Haematological & biochemical changes Urinanlysis• dark coloured, oliguria, acidic PH• high specific gravity with acid reaction• presence of ketones• Diminished or absent chlorides Serum electrolytes Ophthalmoscopic examination-retinal haemorrhages &
detachment ECG-when there is hypokalemia
COMPLICATIONS Neurological- 1. Wernicke encephalopathy—thiamine deficiency2. Korsakoff’s psychosis3. Peripheral neuritis4. Pontine myelinolysis Esophageal rupture—Boerhaave syndrome Oesophageal tear- Mallory -Weiss syndrome Stress ulcer in stomach, Renal failure, convulsions,coma
MANAGEMENTPRINCIPLES IN MANAGEMENT To control vomiting To correct fluids & electrolyte imbalance To correct metabolic disturbances To prevent the serious complications of severe
vomiting Care of pregnancy
FLUIDS Withold oral fluids for 24hrs after cessation of
vomiting IV fluids in 24hrs- total 3 litres, half of which is 5%D &
half RL. Extra amount of 5%D equal to the amount of vomitus
& urine in 24hrs. Correct serum electrolytes
Antiemetics- promethazine(phenergan) prochlorperazine(stemetil), trifluperazine.
metoclopramide stimulates gastric and intestinal motility without stimulating the secretions
Hydrocortisone 100mg I.V for hypotension or intractable vomiting.
Nutritional support-Vit B1,B6,C,B12 Nursing care, Hyperemesis progress chart. Daily record-vitals, I/O chart, urine for acetone, blood
biochemistry, ECG Termination of pregnancy rarely indicated.
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