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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