Download - hyperemesis gravidarum
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HYPEREMESIS GRAVIDARUM
Dr.Sunanda
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DEFINITION ETIOLOGY PATHOLOGY CLINICAL FEATURES INVESTIGATIONS COMPLICATIONS MANAGEMENT
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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.
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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
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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
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CLINICAL COURSE Early-no evidence of dehydration or starvation
Late-evidence of dehydration or starvation
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Features of dehydration and ketoacidosis-• dry coated tongue,• sunken eyes,• acetone smell in the breath • tachycardia,• hypotension• Rise in temperature,• Jaundice
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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
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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
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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
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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
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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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THANK YOU
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