2. INTRODUCTION
• At lest 80% of women experience nausea
&vomiting.
• The term morning sickness is often used to
describe this condition when symptoms usually
disappear after the first trimester.
• this mild form affects the quality of life of women
& her family where the severe form hyperemesis
gravidarum results in dehydration ,electrolyte
imbalance and the need for hospitalization
4. INTRODUCTION
HYPER:
EXCESSIVE
EMESIS: VOMIT
GRAVIDARUM : PREGNANCY
Nausea/vomit of moderate intensity are
especially common until about 16week.
HCG occurswhen vomiting becomes intractable
in early pregnancy &cause fluid & electrolyte
imbalances &nutritionaldeficiency.
women usually needs to be hospitalized.
5. DEFINITION
It is a severe type of vomiting of pregnancy
which has got harmful effect on health of the
patient and/or injure her day-to-day activities
6. E
T
I
O
L
O
G
Y
Limited to 1st trimester
More common in 1st pregnancy
Tendency to recur again in successive
pregnancies
Familial history: Mother and sisters also suffer
from the same manifestation
More prevalent in multiple pregnancy
Common in unplanned pregnancies
Maternal obesity
Smoking
7. RISKFACTORS
Age below 17 years and over 35 years
Primigravidae
Multiple pregnancy
Underweight and obesity
Psychological factors such as unwanted
Pregnancy ,marital problems
history Of Hyper emesis Gravidarum
10. 3.DIETARYDEFICIENCY
Probably due to low carbohydrate reserve as it
happens after a night without food. Deficiency of
vitamin B1,B6 & protein may be the effect
rather than cause.
4. Allergic or immunological basis
5. Decrease gastric motility is found to cause
nausea
11. Clinicalcourse
Early:
• Vomiting throughout day
• Normal day to day activitiesare
disturbed.
• No evidence of dehydration &
starvation
Late:
• Evidence of dehydration and starvation
15. investigation
1.Urinalysis
• Quantity (too see for oliguria)
• Dark colour (due to concentration)
• High specific gravity with acid
reaction
• Presence of acetone, occasional
presence of protein and bile pigments
• Diminished or even absence of
chloride
19. diagnosis
• Pregnancy isconfirmed first
• Associated causesof vomiting are excluded like
Gynecological or Medical or Surgical causes,
• USG –Pregnancy, Hydratiform mole,
Multiple pregnancy
21. COMPLICATIONS
1. Weight loss
2. Dehydration
3. Metabolic acidosis from starvation
4. Alkalosis from loss of HCL
5. Hypokalemia (electrolyte imbalance)
26. hospitalization
• Admit the patient
• Open IV line and correct fluids
• Send for relevant investigations
• Maintain an intake-output chart
• Monitor urine output (catheterize the
patient)
• Monitor the vitals
• Testthe urine periodically for ketone
bodies
27. fluids
• Oral feeding iswith held for at least 24hours
after the cessation of vomiting.
• During this period, fluid given through IV drip
method.
• Theamount of fluid to be infused in 24hours is
calculated as: total amount of fluid approx. 3litres,
of which half is5
%isdextrose and half is Ringer’s
solution.
• Extra amount of 5
%dextrose equal to the amount
of vomitus and urine in 24hours, isto be added.
These measures help to correct dehydration,
electrolyte imbalance and keto- acidosis.
• Enternal nutrition through nasogastric tube may
also be given
28. drugs
Antiemetic:-
• Promethazin -25mgIM BD or
TDS
• Metachlopromide- 10mg IM
• Hydrocortisone:- 100mgIV in
drip
• Prednisolone orally
• Nutritional support:-
Vitamin B1,vitamin B6,
vitamin B12&vitaminC
29. Midwifecare
• Daily monitoring of the patient
• Look for signsof improvement in the
patient: subsidence of vomiting, feeling
hungry, better look, disappearance of
acetone from breath and urine, normal
pulse and blood pressure, normal urine
output.
• Monitor lab results for dehydration
• Monitor FHR,Fetal activity and growth
• Encourage patient to sit in upright after
meal
• Encourage small &frequent meals.
• Liquids should be taken between meals to
avoid distending stomach and triggering
vomit
30. Dietarymanagement
• Before IV fluids isgiven
oral Small and frequent
dry meals without fat are
given.
• First dry carbohydrates
like Biscuit,bread
• Ginger is helpful
• Gradually full diet is
restored