ppt made by Mr. Arkab khan pathan this ppt contain complete lacture notes of HEG. under guidance of Mrs. Rakhi Goar

1. HYPEREMESIS
GRAVIDARUM
PREPARED BY:-
Mr. ARKAB KHAN PATHAN

2. INTRODUCTION:-
HYPER : EXCESSIVE
 EMESIS : VOMIT
 GRAVIDARUM : PREGNANCY
Nausea/vomit of moderate intensity are
especially common until about 16 week.
 HEG occurs when vomiting becomes
intractable in early pregnancy & cause fluid &
electrolyte imbalances & nutritional deficiency.
 women usually needs to be hospitalized.

3. DEFINITION:
“HG IS DEFINEDVARIABLY ASVOMITING
SUFFICIENTLY SEVERETO PRODUCE WEIGHT
LOSS, DEHYDRATION, ACIDOSIS FROM
STARVATION, ALKALOSIS FROM LOSS OF HCL IN
VOMIT & HYPOKALAMIA.”
“SEVEREVOMITING IN PREGNANCY
PERTICULARLY DURING EARLY PREGNANCY
CAUSING DELETERIOUS AFFECTION MOTHER’S
HEALTH SUCH AS WEIGHT LOSS,
DEHYDRATION, ACIDOSIS OCCURS FROM
STARVATION.”

4. ETIOLOGY:-
 Unknown
 More common in-
o Trophoblastic disease
o Multiple pregnancy
o Nuliperity
o Female fetus
o Age > 30year
o Maternal obesity
o Smoking
o Those who had HEG in previous pregnancy
o Has got familial history

5. THEORIES:-
HORMONALTHEORY :
excess of HCG & estrogen trigger vomiting
centre
progesterone excess relaxation of cardiac
sphincter retension of gestric fluid.
PSYCHOGENIC THEORY:
IT PROBABLY AGGRAVATED NAUSEATRIGGER
NEUROGENIC ELEMENTS SOMETIMESTRIGGER

6. DIETARY DEFICIENCY:
Due to low CHO reserve deficiency of vitamin B1,
B6 & protein may be the effect rather than cause.
ALLERGIC OR IMMUNOLOGICAL BASIS
DECREASE GASTRIC MOTILITY
ANY PATHOLOGY OF :
LIVER
KIDNEY
HEART
BRAIN

7. TYPES:
HEG
EARLY LATE
VOMITING
THROUGHOUT
DAY
NO EVIDANCE
OF
DEHYDRATION
& STARVATION
EVIDANCE OF
DEHYDRATION
& STARVATIO
PRESENT

8. CLINICAL FEATURE:-
 SYMPTOM
• Excess vomiting & retching day & night.
• Vomiting initially watery & bilious.(Weight loss seen)
• Oliguria
• Seldom mental symptoms
• EPIGESTRIC pain
• Constipation
• Ptyalism
• Spitting
• Fatigue
• Anorexia

9.  SIGN:
• Dehydration
•Muscle wasting
•Ketosis
•Weight loss > 5% of pregnancy weight
•Tachycardia
•Postural hypotension
•Dry coated tongue
•Sunken eyes
•Acetone smell in breath
CLINICAL FEATURE:-

10. INVESTIGATION:
a) URIN ANALYSIS
b) CBC
c) LIVER FUNCTIONTEST(LFT)
d) THYROID FUNCTIONTEST
e) ULTRASOUND SCAN
f) OPHTHELMOSCOPY

11. MANAGEMENT
 Principles of management:-
 To control vomiting.
 To correct fluid & electrolyte imbalance.
 To correct metabolic disturbance.
 To prevent serious complications of severe
vomiting.

12.  MEDICAL MANAGEMENT:
DRUGS:
Antiemetic:-
Promethazin 25mg IM bd or tds
Trifluopromazine 10mg IM
Metachlopromide 10mg IM
Hydrocortisone:- 100mg IV in drip
Pridnisolone orally
Nutritional support:-
Vitamin B1, vitamin B6, vitamin B12 & vitamin C

13. FLUID:
• 3 ltr 5% dextrose & RL infusion in 24 hrs.
• K+ supplement fluid .
 NURSING MANAGEMENT:-
 Initiate measures to alleviate nausea including
medication therapy. If unsuccessfully on weight
loss & electrolyte imbalances occur, IV
administration of fluid & electrolyte replacement
or total parenteral nutrition may be necessary.
 Monitor lab data & for sign of dehydration &
electrolyte imbalances.

14.  Monitor urine for ketone.
 Monitor fetal heart rate, fetal activity & fetal growth.
 Encourage intake of small proportion of food.
 Liquid should be taken b/w meals to avoid distending
stomach & triggering vomit.
 Encourage patient to sit upright after meal.
NURSING MANAGEMENT

15.  OBSTETRIC CARE:
 No therapeutic abortion is indicated if patient improve on
therapy.
Therapeutic abortion is seldom indicated on-
o Vomiting doesn’t abote on therapy
o if there is risk of complication.

16.  Dehydration
 electrolyte imbalance
 renal failure
Wernicke’s Encephalopathy
(Thiamine deficiency)
Vitamin K deficiency : maternal
coaggulopathy or fetal intracranial
hemorrhage
COMPLICATIONS

17. Mallory Weiss tears
Characterized by upper gastro-intestinal
bleeding secondary to longitudinal mucosal
lacerations at the gastroesophageal junction
or gastric cardia.
COMPLICATIONS

19.  Boerhaave syndrome -
characterized by upper gastrointestinal bleeding
secondary to transmural perforation of the
esophagus
COMPLICATIONS

21.  MANAGEMENT OF NAUSE ANDVOMITING
SYMPTOM:
o Drink & eat little & often.
o Meal high in CHO & low in fat is better.
o Cold meals reduce smell related nausea.
o Avoid caffeine & alcohol as these can
enhancer dehydration.