Hyper emesis gravidarum

1. Hyper emesis gravidarum

2. Outlines ..
 1) Definition
 2) Etiology
 3)Risk factors
 4) Differentiatebetweenmorning sickness & hyperemesis
 5) Singsand symptoms
 6) Maternal& Fetal effectof hyperemesisgravid rum
 7) Therapeuticmanagement
 8) Nursingmanagement

3. Definition ..
Emesis gravid arum “ morning sickness”
 A Sensation of nausea or vomiting especially in
the morning. It appears at the 6th week &
disappears after the 12th week of pregnancy.
 Hyper emesis gravidarum “pernicious
vomiting of vomiting”
 A specific condition that occurs in early
pregnancy characterized by :
-Excessive continues vomiting that affect the
general condition
 Dehydration and loss of body weight
emesis gravidarum affect 50% to 80% of
pregnant women , hyperemesis gravid arum

4. Etiology..
There is no specificcause of hyperemesisbut thereis sometheory..
i. Allergicmanifestation to HCG which are secreted in increasing
amount in early pregnancy.This most accepted theory. Hyperemesis
are more frequentin cases of vesicularmoleas HCG is secreted in
large amount.
ii. Neurosis probably acts as aggravating factor and may be responsible
that a mild vomiting become hyperemesisgravidarum.
iii. Adrenocortical insufficiencyas this predisposesto allergic
phenomena

5. Risk Factors ..
o Multiple pregnancies.
o Women experiencingtheirfirst pregnancy.
o Underweightandobesity.
o Young woman.
o Psycho-social factors such as unwanted.
o Pregnancy, maritalproblem……etc..
o Having a history of HG.
o Being pregnant withmore than onebaby.
o Being a first-timemother.

6. Morningsickness Hyper emesis
 Common
 Usuallyconfined to the morning
 Dose not affects the general
condition.
 Improved about the 12th week of
pregnancy with treatment (e.g.
vitamin B6) or without any
treatment.
 Rare
 Repeated throughout the day
 Affect the general condition
 Hasaggressive course and it
fetal unless efficient treatment is
rapidly given.(almost in the
hospital.
Differentiatebetweenmorning sickness & hyperemesis
gravidarum..

7. Signs & symptom..
 Symptoms :
• The condition usually starts as emesis then is proceed to
hyperemesis
• Continuous vomiting day & night
• Thirst and constipation
• In severe cases the vomitus is bile or blood stained
 Signs :
• Loss of 5% or more of pre-pregnancy body weight (pocket weight)
• Dehydration results in :
 Sunken eye and dry tongue
 The pulse is weak and rapid
 The blood pressure is low
 The temperature is slightly raised
 Decreased vitamin k causes coagulation disorders
 Elevated liver enzyme, jaundice

8. The effectof HEG on the mother..

9. cont..
• Weightloss
• Dehydration
• Electrolyteimbalance“hypokalemia,hypernatremia,acidosisfrom
starvation,alkalosisfrom lossofhydrochloric acidin gastricfluid
• Short termhepaticdysfunction
• Riskfor pretermlabor
• Maternaldeath
• Depressionis commonsecondary complicationofHEG

10. The effect of HEG onthe Fetus

11. Cont..
Intrauterine growth restriction IUGR
Fetal anomalies
If it uncontrolledfetal death may occur IUFD
Low birthweight

12. Therapeuticmanagement
• Laboratory studies for HB , HCT, Na , K , Chloride & creatinine.
• vitamins such as pyridoxine(B6) and thiamine (B1)have consistant evidence of benefit
• Antiemetic promethazine (Phenergan) gives shortterm relief.
• treatment of HG may includeantiemetic medication and IV rehydration .If medication and
IV rehydration are insufficient , nutritional support may be required.
• Thestandard of treatment in most of the worled is benedictin (diclectin) , a combination of
doxylamine succinte(sedating antihistaminic) , and vitamin B6 pyridoxine.
• the drug that act oncentral nervous system ondansetron (Zofran) or metoclopramide
(raglan) may be used.
• management of HG can be complicated because not all women respond to treatment

13. Nursing management..
Assessment
1) Assess for signs of dehydration
2) Assess intake & output.
3) Assess the psychological status of the mother
4) Assess past & current weight .
5)Assess liver enzymes , CBC, HCT , BUN ,……
6)Assess vital signs
7) Assess the presence of ketones in the urine

14. Nursingintervention
Nursingintervention
• provide mouth and skin care.
• Keep clean and quiet environment
• Eat small amount of meals every 2-3hrs
• Low fats and easily digested carbohydrate
• Sleep in a well ventilated room
• provide psychological support.
• Give parenteral fluids: electrolytes, glucose and vitamins according to program
• Provide nutrition in small but frequent portions
• Monitor the provision of fluids and food in 24 hours as well as expenditures and recorded
fluid intake.
• Review of edema in the legs or elsewhere.
• Do collaborations with other teams for the administration of antiemetic drugs.

15. Nursinginterventioncont.
• Give the fooda light, when it is allowedin smallportions
and frequent (liquidand solid)
• Increase feeding of this, if the clientisable to accept
(tolerance).
• Monitor FHR and fetalactivity.
• Monitorsymptoms of morning sickness..
• Examinethe skin: the texture andturgor.
• Encourage clientsto multiplythe rest.
• Create a comfortableenvironment.

16. Planning..
Thenursinginterventionsfocuson:
 Reducing nausea andvomiting.
 Maintainingnutritionand fluidbalance
 Providing emotional support.
Evaluation:
The nurse evaluatethe planfor care onthe basisof
diagnosisand outcome goals.

17. Thank You
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