Hyperemesis Gravidarum is a severe form of vomiting during pregnancy that can negatively impact a mother's health. It affects 0.3-3% of pregnancies and is the most common cause of hospitalization in the first trimester. Risk factors include young or older age, prior history, and multiple pregnancies. Complications can include dehydration, nutritional deficiencies, and problems for the fetus like growth restriction. Treatment involves hospitalization, IV fluids, electrolyte monitoring, antiemetics, and nutritional supplementation. Nursing care focuses on resolving complications through rehydration and nutrition while addressing emotional concerns.

1. HYPEREMESIS
GRAVIDARUM
(PERNICIOUS
VOMITING)

3. DEFINITION
• It is a severe type of vomiting of
pregnancy which has got deleterious
effect on health of the patient and/or
incapacitates her day-to-day activities.
OR
• Hyperemesis Gravidarum is
characterized by severe nausea and
intractable vomiting sufficient to
interfere with maternal nutrition causing
deleterious effect on her health.

4. PREVALENCE
• According to the national health portal 0.3%-
3% pregnant women suffer from hyperemesis
gravidarum – commonest indication for
hospitalization in the first trimester of
pregnancy.

5. ETIOLOGY
• Limited to 1st trimester
• More common in 1st pregnancy
• Tendency to recur again in subsequent pregnancies
• Familial history: Mother and sisters also suffer from the same manifestation
• More prevalent in hydatiform mole and multiple pregnancy
• Common in unplanned pregnancies

6. RISK FACTORS
• Age below 17 years and over 35 years
• Primigravidae with Multiple pregnancy
• Underweight and obesity
• Psychological factors such as unwanted
Pregnancy ,marital problems
• H/O Hyper emesis Gravidarum

7. Theories
• Hormonal
– High HCG (Hydatiform mole, multiple pregnancy)
– High Oestrogen (increased incidence in OCP users)
– High progesterone (relaxation of cardiac
sphincter)
– Other hormones involved (Thyroxin -Prolactin -
Leptin -Adreno-cortisol hormones)

8. • Psychogenic
It probably aggravated nausea once it begins it trigger
neurogenic elements.
• Dietary deficiency
– 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.
• Allergic or immunological basis
• Decrease gastric motility is found to cause nausea

9. Clinical course Early:
• Vomiting throughout day
• Normal day to day activities are disturbed.
• No evidence of dehydration & starvation Late:
• Evidence of dehydration and starvation

11. INVESTIGATION
• Urinalysis
• Biochemical and circulatory
• Opthalmoscopic examination
• ECG

12. DIAGNOSIS
• Pregnancy is confirmed first
• Associated causes of vomiting are excluded
like Gynaecological or Medical or Surgical
causes
• USG –Pregnancy, Hydratiform mole, Multiple
pregnancy

13. COMPLICATIONS
Maternal -
• Neurologic complications —
– Wernicke’s encephalopathy, beriberi due to thiamine deficiency;
– Pontine myelinolysis;
– Peripheral neuritis;
– Korsakoff’s psychosis.
• Stress ulcer in stomach;
• Esophageal tear (MalloryWeiss syndrome);
• Jaundice, hepatic failure;
• Convulsions and coma;
• Hypoprothrombinemia due to vitamin K deficiency and
• Renal failure.

14. Effects on the foetus:
• The effects of vomiting on the foetus depend
on the severity of vomiting. Mild to moderate
vomiting does not have any effect on the
foetus. But hyperemesis, leading to weight
loss of the mother, can cause foetal growth
restriction in one-third of the foetuses.

15. PREVENTION
• Import effective management to correct
simple vomiting of pregnancy.

16. MANAGEMENT PRINCIPLES
• To control vomiting.
• To correct fluid & electrolyte imbalance.
• To correct metabolic disturbance.
• To prevent serious complications of severe
vomiting.

17. 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
• Test the urine periodically for ketone bodies

18. • Oral feeding is withheld for at least 24 hours after the
cessation of vomiting.
• During this period, fluid given through IV drip method.
• The amount of fluid to be infused in 24 hours is calculated
as: total amount of fluid approx 3litres, of which half is 5%
is dextrose and half is Ringer’s solution.
• Extra amount of 5% dextrose equal to the amount of
vomitus and urine in 24 hours, is to be added. These
measures help to correct dehydration, electrolyte
imbalance and keto- acidosis.
• Enteral nutrition through nasogastric tube may also be
given

19. Drugs
• Antiemetic drugs:
– Promethazin -25mg IM BD or TDS
– Trifluopromazine -10mg IM
– Metachlopromide- 10mg IM
• Hydrocortisone:- 100mg IV in drip
• Prednisolone orally
• Nutritional support:- Vitamin B1, vitamin B6,
vitamin B12 & vitamin C

20. NURSING MANAGEMENT
Nursing Diagnosis
• Fluid and electrolyte imbalances related to excessive
vomiting or lack of fluid intake.
• Imbalanced Nutrition Less Than Body Requirements related
to nausea, vomiting or lack of nutritional intake.
• Anxiety related to hyperemesis influence on the health of
the fetus.
• Knowledge deficit related to lack of information about the
treatment of hyperemesis.
• Sleep pattern disturbance related to persistent vomiting.
• Activity Intolerance related to weakness.

21. Nursing Interventions
1. Promote resolution of the complication.
– Make sure that the client is NPO until cessation of
vomiting.
– Administer intravenous fluids as prescribed; they may be
given on an ambulatory basis when dehydration is mild.
– Measure and record fluid intake and output.
– Encourage small frequent meals and snacks once vomiting
has subsided.
– Administer antiemetics as prescribed.
2. Address emotional and psychosocial needs.
– Maintain a non judgmental atmosphere in which
the client and family can express concerns and resolve
some of their fears.

22. • Clinical features of improvement are
evidenced by —
• subsidence of vomiting
• feeling of hunger
• better look
• normalization of blood biochemistry
(electrolytes)
• disappearance of acetone from the breath and
urine
• normal pulse and blood pressure
• normal urine output.

23. Dietary management:
• Before IV fluids is given oral Small and
frequent dry meals without fat are given.
• First dry carbohydrates like Biscuit, bread and
toast
• Ginger is helpful
• Gradually full diet is restored