Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy, leading to weight loss and dehydration. Its etiology is largely unknown but is associated with factors like multiple pregnancies and maternal obesity, with management focused on controlling symptoms and correcting imbalances. Treatment includes medication, nutritional support, and careful monitoring, while potential complications may involve serious dehydration and gastrointestinal issues.

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.