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Intractable vomiting associated with
• loss of more than 5% of pre-pregnancy weight
• dehydration
• electrolyte disturbances or
• need for hospital admission
Young age
Primigravidae
Multiple pregnancy
Molar pregnancy
Family history
Hyperthyroidism
• ↑ HCG
• ↑ estrogen
• ↑ progesterone – decreases gastric motility
Hormonal
• Low carbohydrates
• Vitamin B6 deficiency
Dietary deficiency
Psychogenic
Peptic ulcers Cholecystitis
Acute
gastroenteritis
Hepatitis Pancreatitis Drug induced
Genitourinary
infections
Chronic
infection with
H. pylori
Metabolic/
neurological
conditions
• PUQE-24 score – Pregnancy-Unique Quantification of Emesis
• Mild: ≤ 6
• Moderate: 7- 12 Total 15
• Severe: 13 - 15
History
Examination
Investigations
Treatment
Temperature
Pulse
Blood pressure
Oxygen saturations
Respiratory rate
Weight
Abdominal examination
Signs of dehydration
Signs of muscle wasting
Other examination as guided
by history
urine ketones
Hyponatremia
Hypokalemia
Low S. Urea
Raised haematocrit
Ketonuria
Metabolic
acidosis
Complications…
Abnormal thyroid
function tests
Abnormal liver
function tests
Pontine demyelination
Thrombosis
Peripheral neuropathy &
megaloblastic anemia
Wernicke’s
encephalopathy
1. Maintain hydration
2. Control vomiting
3. Correct the fluids and electrolytes imbalance
4. To prevent the complications of severe vomiting
5. Care of pregnancy
1. Continued nausea & vomiting + inability to
keep down oral antiemetics
2. Continued nausea & vomiting + ketonuria
and/ or weight loss (˃5% body weight),
despite oral antiemetics
3. Confirmed or suspected comorbidity (eg.
UTI and inability to tolerate oral antibiotics)
At least one of
the following
Weight of the patient – on admission twice weekly
Nil per orally for initial 24 hours
Intravenous fluids
Daily S. urea & S. electrolytes monitoring
Thiamine supplementation
Drugs
Thromboprophylaxis
First line – Anti-histamines and Phenothiazines
Combination of different drugs should be used in those who
do not respond to single agent
Parenteral/ rectal route – in persistent cases
First line
• Cyclizine
• Prochlorperazine (Stemetil)
• Promethazine (Avomine)
• Chlorpromazine (Largactil/ Thorazine)
Second line
• Metoclopramide (Perinorm)
• Domperidone (Domstal)
• Ondansetrone (Emeset/ Ondem)
Third line • Corticosteroids
• Normal saline + KCl – best
hydration
• Dextrose containing fluids
• Can precipitate
Wernicke’s
encephalopathy
• High dose thiamine
supplementation
Hyperemesis Gravidarum e.pptx
Hyperemesis Gravidarum e.pptx
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