HG Pathophysiology Risks Complications Management
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severe nausea and vomiting during pregnancy which can worse even to death
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HG Pathophysiology Risks Complications Management
- 1. HYPEREMESIS GRAVIDARUM Hari Prakash Bharathi Group 4 Year 6 Faculty of Medicine Tbilisi State Medical University 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 1
- 2. WHAT IS HG? Severe vomiting continuing after 16 gw and not resolved by diet or antiemetic. Characterized by weight loss, ketosis, alkalosis, dehydration and hypokalemia 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 2
- 3. RISK FACTORS Hyperthyroidism GI abnormality Pregestational diabetes Psychiatric illness Asthma Female fetus or multiple fetuses Multiple gestation Previous HG Nulliparity Trophoblastic diseases Obesity 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 3
- 4. EPIDEMIOLOGY More prominent in urban than rural areas About 10% of pregnant women Less in American Indians, Africans, some Asians Risk decrease in increase in maternal age. 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 4
- 5. ASSOCIATED THEORIES FOR PATHOPHYSIOLOGY Hormonal Gastrointestinal dysfunction Infection Vestibular and olfaction Metabolic derangement 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 5
- 6. HORMONAL THEORY High hCG high TSH elevated T4 nausea Critics: ο nausea and vomiting not a symptom of hyperthyroidism ο Severity of symptoms ο Signs of biochemistry is not universal in all HG. 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 6
- 7. GASTROINTESTINAL DYSFUNCTION Thyroid disorder Elevated estrogen or progesterone vasopressin Abnormal myoelectric activity Gastric dysrhythmias Nausea 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 7
- 8. VESTIBULAR AND OLFACTION Smell of meat, cooking foods, certain food items triggers nausea Morning sickness is might be due to vestibular disorder. 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 8
- 9. 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 9
- 10. CLINICAL PRESENTATION Sleeping disturbance Hyper olfaction Dysgeusia Ptyalism Mood changes Decreased gustatory movements Weight loss by 10% Dehydration, ketosis Ketoacidosis or thyrotoxicosis Physical and emotional stress on pregnancy Difficulty in daily activities 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 10
- 11. PUQE CLASSIFICATION 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 11
- 12. COMPLICATION IN WOMEN Anemia Hyponatremia Mallory Weiss tears Hypoglycemia Malnutrition Acute renal failure DVT, pulmonary embolism Esophageal perforation or rupture Wernicke encephalopathy Hepatic disease Seizures, coma or death Pneumothorax or pneumomediastinum Vitamin deficiency 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 12
- 13. COMPLICATION IN FETUS LBW Small for gestational Preterm Intracranial hemorrhage If mother gain atleast 7 kg than there is less complication 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 13
- 14. MANAGEMENT Diet modification More fluids Vitamins Ginger extract Antiemetics and IVFs Pyridoxine/doxylamine + vit B6 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 14
- 15. 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 15
- 16. NOTABLE CASES Catherine William, Duchess of Cambridge during her both pregnancy Charlotte Bronte died at her 4th month of pregnancy 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 16
- 17. THANK YOU 08-12-2016 TBILISI STATE MEDICAL UNIVERSITY 17