HYPEREMESIS GRAVIDARUM by zahirmehmoodfarwa

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   Vomiting during pregnancy is not
   a vomiting severe enough to require
    hospital admission is called hyperemesis
   Hyperemesis      gravidarum      typically
    presents before 16 wks gestation
   Diagnosis is mainly clinical
   Differential diagnosis includes
     Enteric infection
     Hepatitis

     Hyper calcemia

     Benign intra cranial hypertension

     Reflux oesophagitis
   Excessive vomiting occurring during
    third trimester is unlikely to be
    hyperemesis gravidarum
   May be due to acute fatty liver, biliary
    and other diseases
   Gastritis
   Appendicits
   infections
   Odours
   Diet
   HCG
   Oestrogens
   thyroxine
   Altered taste
   Sensitivity of brain to motion
   Full stomach
   Physical emotional stress
   Sub conjunctival haemorrhage
   Daily activities
   Hallucinations
   Weight loss (05 – 30%)
   Hyperolfactorism
   ptyalism
   Maternal
   Renal failure
   Pontine haemorrhages
   Myelinolysis
   Coagulopathy
   Mallory W syndrome
   Hypoglycemia
   Jaundice
   Pneumomediastinum
   Rhabdo myolysis
   Vaso spasm of cerebral arteries
   Vitamin deficiency
Fetal Complications
   SGA
   PTL
   LBWB
   Total weight gain of pregnancy
   Women affected by hyperemesis
    gravidarum are
     Dehydrated
     Have electrolyte imbalance

     Protein calorie malnutrition

     Vitamin deficiency
   In severe form liver function tests are
    deranged       and    patient    develops
   Flexible endoscopy can exclude upper
    gastro intesitinal cause of vomiting
   The procedure is safe in pregnancy
Management includes
   Hospital admission
   Rest
   Reassurance
   Correction of fluid and electrolyte balance by
    I/V supplement therapy & repeated testing
   Vitamin supplement is advisable, should
    always include thiamine since wernicke’s
    encephalopathy is known to complicate
    severe hyperemesis gravidarum
   Drug therapy: may include
   Antiemetics like meclozine, promothazine and
   Doxylamine & Vit B6
   Ondansetron
   Transdermal scopolamine may also be used
   These drugs are safe in pregnancy
   Thiamine supplements
   I/V nutrition
   Patient is kept fasting initially
   On I/V therapy until she is well
    hydrated & electrolytes are corrected
   Oral food – introduced gradually
   Patient’s diet needs special attention
   Dietitian’s advise - helpful
   Patients do well on – small
    frequent meals
   diet with carbohydrate and low fat
    in often well tolerated
Advise for home
   Keep head side up
   Frequent small meals to avoid gastro
    oesophageal reflux
   Alginates and metoclopramide may be
   Oesophagitis may be helped with
   Derangements generally correct
    themselves once general condition of
    the patient improves and hyperemesis
    is controlled
   Recently steroid therapy has been
    suggested for the control of
Fetal outcome: generally good
Remote       delayed     consequences       of
  disturbedintra uterine nutrition – even
  manifesting as late as 7th decade of life as
  ↑ed risk of ischemic heart disease
•   PTL
•   LBWB
•   SGA

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