1. Other Complication in
Pregnancy
Hyperemesis gravidarum
Diabetes in Pregnancy

2. Hyperemesis gravidarum
• Definition:
• Hyperemesis gravidarum is exaggerated
nausea and vomiting during pregnancy
persisting past the first trimester.
complication of pregnancy

3. Hyperemesis Gravidarum
• Incidence
0.3% to 1% of all pregnancies

4. Pathophysiology/Etiology
1. Cause unknown but may possibly result from high
levels of hCG or estrogen.
2. Psychological factors including neurosis or altered
selfconcept may be contributory.
3. Seen in molar pregnancies, multiple
gestation, and history of hyperemesis in previous
pregnancies.
4. Slowed gastric motility occurs.
5. The persistent vomiting may result in fluid and
electrolyte imbalances, dehydration, jaundice, and
elevation of serum transaminase.
complication of pregnancy

5. Clinical Manifestations
1. Persistent vomiting; inability to tolerate
anything by mouth
2. Dehydration—fever, dry skin, decreased
urine output
3. Weight loss (up to 5-10% of body weight)
4. Severity of symptoms increases as the
disease progresses.
complication of pregnancy

6. Diagnostic Evaluation
1. Tests may be done to rule out other conditions
causing vomiting (cholecystitis, appendicitis).
2. Liver function studies—elevated aspartate
aminotransferase up to four times normal in
severe cases.
3. Prothrombin time, partial thromboplastin time
usually normal
4. Blood urea nitrogen (BUN) and creatinine—may
be slightly elevated
5. Serum electrolytes—may be hypokalemia, hypoor hypernatremia
6. Urine for ketones—positive
complication of pregnancy

7. Hyperemesis Gravidarum
• Goals of Care
1. Maintain hydration
2. Support nutrition
3. Treatment of nausea and vomiting

8. Management
1. Try withholding food and fluid for 24 hours, or until vomiting
stops and appetite returns; then restart small feedings.
2. Control of vomiting may require antiemetic such as
prochlorperazine (Compazine) in injectable or rectal
suppository form.
3. Control of dehydration through IV fluids—often 1 to 3 liters of
dextrose solution with electrolytes and vitamins, as needed.
Bicarbonate may be given for acidosis.
4. Most women respond quickly to restricting oral intake and
giving IV fluids, but repeated episodes may occur.
5. Rarely, total parenteral nutrition is needed.
6. Rarely, complications of hepatic or renal failure or coma could
result from disease progression.
7. Rarely, cessation of pregnancy- induced abortion/ delivery
complication of pregnancy

9. Nursing Assessment
1. Evaluate weight gain or loss pattern.
2. Evaluate 24- or 48-hour dietary recall.
3. Evaluate environment for factors that may
affect the woman's appetite.
4. Monitor vital signs for tachycardia,
hypotension, and fever due to dehydration.
5. Assess skin turgor and mucous
membranes for signs of dehydration.
complication of pregnancy

10. Nursing Diagnoses
A. Risk for Fluid Volume Deficit, Electrolyte
Imbalance related to prolonged vomiting
B. Altered Nutrition (Less than Body
Requirements) related to prolonged
vomiting
C. Ineffective Individual Coping related to
stress of pregnancy and illness
complication of pregnancy

11. Nursing Interventions
A. Maintaining Fluid Volume
1. Establish an IV line and administer IV fluids as prescribed.
2. Monitor serum electrolytes and report abnormalities.
3. Medicate with antiemetics as prescribed.
a. Administer intramuscularly or by rectal suppository to avoid
loss of dose through vomiting.
4. Maintain NPO status except for ice chips until vomiting has
stopped.
5. Assess intake and output, vital signs, skin turgor, and fetal
heart tones as indicated by condition.
complication of pregnancy

12. B. Encouraging Adequate Nutrition
1. Advise the woman that oral intake can be restarted
when emesis has stopped and appetite returns.
2. Begin small feedings. Suggest or provide bland solid
foods; serve hot foods hot and cold foods cold; do not
serve lukewarm.
a. Avoid greasy, gassy, and spicy foods.
b. Provide liquids at times other than meal times.
3. Suggest or provide an environment conducive to
eating.
a. Keep room cool and quiet before and after meals.
b. Keep emesis pan handy, yet out of sight.
complication of pregnancy

13. C. Strengthening Coping
Mechanisms
1. Allow patient to verbalize feelings
regarding this pregnancy.
2. Encourage patient to discuss any
personal stress that may have a negative
effect on this pregnancy.
3. Refer to social service and counseling
services as needed.
complication of pregnancy

14. Diabetes in Pregnancy
1. Review pathophysiology
2. Impact of pregnancy
3. Goals of care

15. Review
Pancreas
Insulin
Glucagon

16. Review
1. Insulin –
Protein hormone that causes decrease
blood level of glucose.
2. Glucagon –
Protein hormone that causes increase
blood level of glucose.

17. The body uses glucose as
the primary source of
energy.
Glycogen is stored glucose
– for times when glucose
is not available (i.e. when
the person is not eating).

18. Review
Insulin
Helps glucose leave
the blood and enter
the cells.
Stimulates liver and
muscle cells convert
glucose into
glycogen
Promotes transfer of
amino acids into
cells.

19. Review
Diabetes is a disorder of insulin:
1. Altered production of insulin (Type 1)
2. Altered response to insulin (Type 2)

20. Review
Diabetes is a disorder of insulin:
Type 1 =
Total deficiency of insulin secretion
by pancreatic beta cells.

21. Review
Diabetes is a disorder of insulin:
Type 2 =
Cells resist the action of insulin, and
the pancreas does not respond
adequately by producing more insulin.

22. The effect of both types
of diabetes is too much
glucose in the blood
(hyperglycemia),
and not enough glucose
in the cells (hungry
cells).

23. Disorder of insulin
production or response
also causes abnormal
metabolism of proteins,
fats and electrolytes.

24. Symptoms of Diabetes
1.
2.
3.
4.
5.
6.
Extreme thirst and hunger
Frequent urination
Fatigue
Blurred vision
Weight loss
Recurrent infections

25. Complications of Diabetes
1. Hyperglycemia
- thirst
- sugar in urine, and excessive urine production
- weight loss
2. Increased circulation of fatty acids
- ketones in body and urine
- fat build up in blood vessels
- risk of ketoacidosis

26. Complications of Diabetes
3. Microvascular disease
- eye damage
- kidney damage
4. Neuropathy
- nerve damage of organs
- vascular occlusion
- death of tissue in extremities

27. Treatment of Diabetes
1. Type 1 –
Need insulin shots
2. Type 2 –
May be controlled with diet,
exercise and/or medications

28. Diabetes in Pregnancy
Definition:
Glucose intolerance (hyperglycemia)
that begins or is first recognized
in pregnancy is called
gestational diabetes.

29. Diabetes in Pregnancy
1. Occurs in about 7% of all pregnancies
2. Higher incidence in African, Hispanic,
and Asian populations
3. Uncontrolled diabetes (all types) causes
increase risk for maternal and fetal
death and complications

30. Diabetes in Pregnancy
Pregnancy Complications:
1.
2.
3.
4.
Increased risk of fetal death
Increased risk for fetal defects
Increased risk for hypertension
Increased risk for large baby

31. Diabetes in Pregnancy
Pregnancy Complications:
Maternal hyperglycemia causes
babies to be fatter.
Fatter babies are more difficult to
deliver and face greater risk of
birth trauma.

32. Diabetes in Pregnancy
Remember!
Maternal insulin does
NOT cross the placenta.
The baby makes it’s
own insulin.

33. Diabetes in Pregnancy
This is why when the maternal
source of glucose is cut off at
delivery,
babies who have been over
producing insulin
(to keep up with lots of sugar coming from mother)
may become very
hypoglycemic.

34. Diabetes in Pregnancy
Pregnancy
complications can be
managed with really
good care.

35. Diabetes in Pregnancy
Goals of Care:
1. Maintain normal glucose levels
2. Identify and manage complications

36. Diabetes in Pregnancy
Care:
1. Identify women at risk
2. Counsel women on disease, diet, exercise, and
medication
3. Monitor maternal glucose levels
4. Monitor fetal growth and well being