2. VOMITING DURING PREGNANCY USUALLY STARTS EARLY
ABOUT 6TH OR 8TH WEEK, PASSES OFF BY THE 12TH WEEK.
1ST TRIMESTER IT IS MILD, ITS FREQUENCY BEING ONCE OR
TWICE IN THE MORNING & THE QUANTITY SMALL & IT
DOES NOT AFFECT THE MOTHER’S HEALTH.
SOMETIMES THE VOMITING PERSISTS, INCREASES IN
FREQUENCY, VERY LITTLE NOURISHMENT IS RETAINED &
THE PATIENT LOSES WEIGHT. THIS EXCESSIVE VOMITING
IN PREGNANCY IS CALLED HYPEREMESIS GRAVIDARUM.
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3. HYPER = EXCESSIVE
EMESIS = VOMITING
GRAVIDA = PREGNANT.
DEFINITION:
IT IS A SEVERE TYPE OF VOMITING OF
PREGNANCY WHICH HAS GOT DELETERIOUS
EFFECT ON THE HEALTH OF THE MOTHER
&/OR INCAPACITATES HER IN DAY TO DAY
ACTIVITIES.
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4. AETIOLOGY
FIRST TRIMESTER
FIRST PREGNANCY.
FAMILIAL HISTORY.
HYDATIDIFORM MOLE
MULTIPLE PREGNANCY
UNPLANNED
PREGNANCIES
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6. PATHOLOGY
LIVER: CENTRILOBULAR FATTY INFILTRATION
WITHOUT NECROSIS
KIDNEYS: FATTY CHANGE IN CELLS OF CONVOLUTED
TUBULES.
HEART: SUBENDOCARDIAL HAEMORRHAGE.
BRAIN: WERNICKE’S ENCEPHALOPATHY.
METABOLIC: KETOACIDOSIS.
BIOCHEMICAL: LOSS OF WATER, SODIUM, POTASSIUM &
CHLORIDES.
CIRCULATORY: HAEMOCONCENTRATION
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7. CLINICALFEATURES
EARLY:
VOMITING OCCURS INDEPENDENT OF FOOD.
VOMITUS CONTAINS BILE STAINED FLUID OR FOOD
NORMALACTIVITIES ARE CURTAILED.
NUTRITION DOES NOT SUFFER
O/E SHE LOOKS WELL & NO ABNORMALITY IS
DETECTED.
BLOOD BIOCHEMISTRY & URINALYSIS REVEAL NO
ABNORMALITY.
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8. LATE:
SYMPTOMS:
VOMITING IS INCREASED IN AMOUNT &
FREQUENCY.
VOMITUS MAY BE COFFEE GROUND OR EVEN
CONTAIN BLOOD.
URINE QUANTITY REDUCED EVEN TO STAGE OF
OLIGURIA.
CONSTIPATION, AT TIMES DIARRHOEA.
EPIGASTRIC PAIN
PATIENT IS CONFINED TO BED.
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9. WERNICKE’S ENCEPHALOPATHY- MENTAL
APATHY, RESTLESSNESS, SLEEPLESSNESS,
CONVULSION OR EVEN COMA.
KORSAKOFF’S PSYCHOSIS- MENTAL
CONFUSION WITH LOSS OF MEMORY OF
RECENT EVENTS.
EYE COMPLICATIONS- DIPLOPIA, DIMNESS
OF VISION OR EVEN BLINDNESS.
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10. SIGNS:
PROGRESSIVE EMACIATION WITH LOSS OF
WEIGHT.
ANXIOUS LOOK.
EYES- SHRUNKEN, APATHETIC & DULL.
SKIN IS LUSTRELESS & INELASTIC.
TONGUE- DRY, BROWN, THICKLY COATED
TEETH COVERED WITH SORDES.
BREATH – ACETONE SMELL
TACHYCARDIA
HYPOTENSION
VAGINAL EXAMINATION TO CONFIRM THE
DIAGNOSIS OF PREGNANCY.
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11. INVESTIGATIONS
URINALYSIS:
QUANTITY – LESS
DARK COLOUR
TEST FOR ACETONE POSITIVE
OCCASIONAL PRESENCE OF PROTEINS.
BIOCHEMICAL & CIRCULATORY CHANGES:
HAEMOCONCENTRATION
HYPONATREMIA
HYPOKALEMIA
OPTHALMOSCOPIC EXAMINATION IS
REQUIRED IF PATIENT IS SERIOUSLY ILL.
ECG WHEN THERE IS ABNORMAL
POTASSIUM LEVEL.
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13. GENERALMANAGEMENT
ISOLATION: MILD CASES IMPROVE BY CHANGES OF
PLACE. SEVERE CASE IS HOSPITALISED.
DIET: MILD CASE: FREQUENT CARBOHYDRATE MEAL.
SEVERE CASE: NIL BY MOUTH BUT PARENTERAL
FEEDING.
VITAMIN B1, B6 SUPPLEMENTS ARE GIVEN
FOR DEHYDRATION: 3 LITRES OF 5% GLUCOSE
SALINE & RINGER LACTATE SOLUTION ARE INFUSED IN
24 HRS..
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14. HYPEREMESIS CHART
FLUID IN TAKE & OUT PUT IN 24 HRS
CHARACTER OF VOMITUS
RECORD OF VITAL SIGNS AT LEAST TWICE
DAILY
URINE EXAMINATION TWICE DAILY
BLOOD BIOCHEMISTRY
WEIGHT OF PATIENT
ECG
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15. INDICATION FOR TERMINATION:
PROGNOSIS WORSENING INSPITE OF
THERAPY
RISING PULSE RATE OF > 100/MINUTE
INCREASING OLIGURIAAND PROTEINURIA
APPEARANCE OF JAUNDICE
APPERANCE OF NEUROLOGICAL
COMPLICATIONS
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16. HOMOEOPATHIC THERAPEUTICS
ASARUM EUROPIUM
NAUSEA <AFTER EATING
CLEAN TONGUE
ACCUMULATION OF COLD WATERY SALIVA
DESIRE FOR ALCOHOLIC DRINKS
VOMITING OF GREENISH SOUR FLUID WITH GREAT
STRAININ & SENSATION ABOUT THE EARS AS IF
THE HEAD WOULD SPLIT
CHILLY PATIENT
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17. CHELIDONIUM
NAUSEA VOMITING > VERY HOT WATER
UNLESS BOILING HOT, THE STOMACH WILL
NOT RETAIN
EATING RELIEVES TEMPORARILY
BITTER TASTE IN MOUTH
NAUSEA WITH HEAT IN STOMACH
SHORT BREATH & ANXIETY > BY BELCHING
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18. JATROPHA
NAUSEA & VOMITING BROUGHT ON BY
DRINKING WITH ACRID FEELING FROM
THROAT
GREAT THIRST
VERY EASY VOMITING
HICCOUGH FOLLOWED BY COPIOUS
VOMITING
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19. KREOSOTE
ACTS ON MUCOUS MEMBRANE OF STOMACH
CAUSING BURNING & EXCORIATING DISCHARGES
NAUSEA & VOMITING OF FOOD SEVERAL HOURS
AFTER EATING
VOMITUS OF SWEETISH WATER IN MORNING
BITTER TASTE AFTER A SWALLOW OF WATER
FEELING OF COLDNESS OF ICE WATER IN
STOMACH
CHILLY PATIENT
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20. LACTIC ACID
NAUSEA ESPECIALLY IN PALE ANAEMIC
WOMEN
COPIOUS SALIVATION & WATER BRASH
NAUSEA> EATING
GREAT THIRST
TONGUE DRY PARCHED
VORACIOUS HUNGER
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21. NAT SULPH
VOMITING FIRST SOUR, THEN BITTER
CONSTANT RISING OF SOUR WATER
BROWN, BITTER COATING ON TONGUE
THIRST FOR SOMETHING COLD
VOMITING WITH COLIC
CHILLY PATIENT
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22. NUX MOSCH
NAUSEA & VOMITING WITH INCLINATION TO
SLEEP
SPASMODIC VOMITING DURING PREGNANCY
DRY MOUTH YET NO DESIRE FOR WATER
SALIVA LIKE COTTON
STOMACH EXCESSIVELY BLOATED
CHILLY PATIENT
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23. NUX VOMICA
SOUR TASTE & NAUSEA IN THE MORNING, AFTER
EATING WITH FAINTING
WEIGHT & PAIN IN STOMACH < EATING ,
SOMETIME AFTER
NAUSEA & VOMITING WITH MUCH RETCHING
WANTS TO VOMIT BUT CANNOT
FEELS BETTR BY INDUCING VOMITING
AVERSION FOR NORMAL DIET
CHILLY PATIENT
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24. SEPIA
NAUSEA & VOMITING AT THE SMELL , SIGHT OR
EVEN THOUGHT OF FOOD BUT > BY EATING
NAUSEA WORSE WHEN LYING ON SIDE
NAUSEA IN THE MORNING BEFORE EATING
VOMITING OF MILKY WATERY ESPECIALLY IN
EARLY MORNING HOURS
TYPICAL SESATION AS SOMETHING IS MOVING IN
THE ABDOMEN
CHILLY PATIENT
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25. TABACUM
INCESSANT NAUSEA < SMELL OF TOBACCO
SMOKE
NAUSEA & VOMITING ON LEAST MOTION
DEATHLY NAUSEA
VOMITING OF WATER; SOUR FLUID, WITH
MUCUS.
VOMITING WITH MUCH SPITTING
HOT PATIENT
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26. SYMPHORICARPUS RACEMOSA
ONLY NAUSEA & VOMITING
NO OTHER SYMPTOMS
ONLY ON MAIN SYMPTOM THIS DRUG CAN BE
PRESCRIBED
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