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HYPEREMESIS GRAVIDARUM
Presented by: Syeda Ambreena Batool
Roll no: 29
BEMS Final Proff
Submitted to: Mam Farah Zafar
Definition
• Severe,persistent nausea and vomiting during pregnancy typically
leads to weight loss, fluid and electrolyte imbalance and
deficiencies in nutrition and require hospital admission.
• Presents before 16 weeks gestation.
Spectrum Representation
mild severe
RiskFactors
• Multiple gestation
• Hyatidiform mole(ruled
on USG)
• History of hyperemesis
gravidarum
• Corelation with
migraine headache
• H.pylori infection
• Family history
• Hyperthyroidism
• Pregestational diabetes
• High BMI(Trophoblastic
disease)
• Nulliparity
• Asthma
Pathophysiology
• Occurs in first trimester and gradually improves over time.
• Most often 5-6 weeks into gestation.
• Related to increase in Beta-hCg.
• In first trimester Beta-hCG rapidly increases from placental
cells it stimulates corpus luteum to produce progesterone and
over time Beta-hCG declines.
• Estradiol: similar pattern of increases and decreases.
• Estradiol along with progesterone causes relaxation of lower
esophageal sphincter leading to gastric reflux and nausea.
• High placenta weight.
Clinical Features
• Signs of dehydration(dry mucous membrane)
• Low BP due to lower Blood volume
• High HR due to low BP
• Significant appetite loss
• Electrolyte disturbance
• Protein calorie malnutrition
• Vitamin deficiency
• Weight loss
• Fatigue
• In severe form, liver function tests are deranged and the
patient develops jaundice.
Other Findings
• Hyperolfaction
• Ptyalism
• Altered taste perception
- Dysgeusia
- Decreased taste
- Sleep disturbances
- Weakness
- Presyncope/dizziness
- Orthostatic hypotension
Complication
• Mallory-Weiss tears
-streaks of blood in vomit
• Electrolyte imbalances
-Hypokalemia(can cause cardiac arrhythmias)
• Wernicke’s Encephalopathy
-due to thiamine deficiency
Clinical Diagnosis
• History and symptoms of excessive intractable nausea and
vomiting.
• Rule out other conditions including Pre-eclampsia and HELLP
syndrome.
• Differentiate HG from enteric
infection,hepatitis,hypercalcemia,benign intracranial
hypertension and reflux esophagitis.
Excessive vomiting occurring during third trimester is extremely
unlikely to be hyperemesis gravidarum may be due to acute fatty
liver,biliary and other diseases.
Clinical Findings
• Signs of volume depletion(dry mucous membrane,tounge may
be dry,sunken eyes,decreased skin turgor,low Blood
pressure,dizziness).
• Ketosis.
• BLOOD WORK: -Thyroid hormones.
-Liver enzymes.
-Blood urea nitrogen/creatinine.
-Bilirubin level.
-Amylase,lipase,calcium levels.
Imaging: USG to assess for gestational trophoblastic disease,
multiple gestations.
Flexible endoscopy can exclude upper gastrointestinal cause of
vomiting and the procedure is said to be safe during pregnancy.
How to Manage?
• Hospital admission
• Rest reassurance
• Correction of fluid
• Electrolyte balance by intravenous supplement therapy and
repeated testing.
• Vitamin supplement(thiamine: due to Wernicke’s
encephalopathy)
• Drug therapy: anti-emetics(meclozine, promethazine,
metoclopramide).
• Intravenous dimenhydrinate 50 mg every four to six hours,
metoclopramide 5 to 10 mg every eight hours, or
promethazine 12.5 to 25 mg every four to six hours
transdermal scopolamine may be used.
• Patient initially kept fasting and on intravenous therapy until
she is well hydrated and the electrolytes are corrected.
• Oral food. Small but frequent meal rather than full three time
meals a day.
• Diet containing carbohydrates and low fat is often tolerated
well.
• Advised the patient to keep her head side up and take
frequent small meals to avoid gastroesophageal reflux.
Management of Vomiting
‫ھوالشافی‬
1
‫اناریں‬ ‫جوارش‬ ‫۔‬
7
‫زرشک‬ ‫شیرہ‬ ‫سے‬ ‫اوپر‬،‫دیں‬ ‫کھال‬ ‫پہلے‬ ‫ماشہ‬
3
‫شیرہ‬ ،‫ماشہ‬
‫خشک‬ ‫پودینہ‬
3
‫بخارا‬ ‫آلو‬ ‫شیرہ‬،‫ماشہ‬
5
‫بادیان‬ ‫عرق‬،‫دانہ‬
12
‫کر‬ ‫نکال‬ ‫میں‬ ‫تولہ‬
‫غورہ‬ ‫شربت‬
2
‫دیں۔‬ ‫کرکے‬ ‫شامل‬ ‫تولہ‬
2
‫االئچی‬ ‫دانہ‬،‫سرخ‬ ‫گل‬،‫السوس‬ ‫اصل‬،‫کیلیے‬ ‫روکنے‬ ‫کو‬ ‫قے‬ ‫بعد‬ ‫کے‬ ‫کھانے‬ ‫۔‬
‫ایک‬ ‫ہر‬ ‫خشک‬ ‫آملہ‬،‫خرد‬
5
‫خشک‬ ‫ماشہ۔کنیز‬
7
‫سفوف‬ ‫کر‬ ‫چھان‬ ‫کوٹ‬ ‫ماشہ‬
‫بنائیں۔‬
6
‫کھالئیں۔‬ ‫ہمراہ‬ ‫کے‬ ‫پانی‬ ‫سفوف‬ ‫ماشہ‬
،
3 ‫۔‬
‫حب‬
‫تنکار‬
،
‫گیسٹوفل۔‬
Management of Thiamine
deficiency
Prompt administration of parenteral thiamine is indicated. The
recommended dose is 50 mg given intravenously or
intramuscularly for several days. The duration of therapy
depends on the symptoms, and therapy is indicated until all
symptoms have disappeared.
Diet: -Fortified breakfast cereals.
-Fish.
-Beans, lentils.
-Green peas.
-Enriched cereals, breads, noodles, rice.
-Sunflower seeds.
-Yogurt.
HYPEREMESIS GRAVIDARUM (intractable nausea and vomiting during pregnancy typically leads to weight loss and loss of appetite, electrolyte imbalance.

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HYPEREMESIS GRAVIDARUM (intractable nausea and vomiting during pregnancy typically leads to weight loss and loss of appetite, electrolyte imbalance.

  • 1. HYPEREMESIS GRAVIDARUM Presented by: Syeda Ambreena Batool Roll no: 29 BEMS Final Proff Submitted to: Mam Farah Zafar
  • 2. Definition • Severe,persistent nausea and vomiting during pregnancy typically leads to weight loss, fluid and electrolyte imbalance and deficiencies in nutrition and require hospital admission. • Presents before 16 weeks gestation. Spectrum Representation mild severe
  • 3. RiskFactors • Multiple gestation • Hyatidiform mole(ruled on USG) • History of hyperemesis gravidarum • Corelation with migraine headache • H.pylori infection • Family history • Hyperthyroidism • Pregestational diabetes • High BMI(Trophoblastic disease) • Nulliparity • Asthma
  • 4. Pathophysiology • Occurs in first trimester and gradually improves over time. • Most often 5-6 weeks into gestation. • Related to increase in Beta-hCg. • In first trimester Beta-hCG rapidly increases from placental cells it stimulates corpus luteum to produce progesterone and over time Beta-hCG declines. • Estradiol: similar pattern of increases and decreases. • Estradiol along with progesterone causes relaxation of lower esophageal sphincter leading to gastric reflux and nausea. • High placenta weight.
  • 5. Clinical Features • Signs of dehydration(dry mucous membrane) • Low BP due to lower Blood volume • High HR due to low BP • Significant appetite loss • Electrolyte disturbance • Protein calorie malnutrition • Vitamin deficiency • Weight loss • Fatigue • In severe form, liver function tests are deranged and the patient develops jaundice.
  • 6. Other Findings • Hyperolfaction • Ptyalism • Altered taste perception - Dysgeusia - Decreased taste - Sleep disturbances - Weakness - Presyncope/dizziness - Orthostatic hypotension
  • 7. Complication • Mallory-Weiss tears -streaks of blood in vomit • Electrolyte imbalances -Hypokalemia(can cause cardiac arrhythmias) • Wernicke’s Encephalopathy -due to thiamine deficiency
  • 8. Clinical Diagnosis • History and symptoms of excessive intractable nausea and vomiting. • Rule out other conditions including Pre-eclampsia and HELLP syndrome. • Differentiate HG from enteric infection,hepatitis,hypercalcemia,benign intracranial hypertension and reflux esophagitis. Excessive vomiting occurring during third trimester is extremely unlikely to be hyperemesis gravidarum may be due to acute fatty liver,biliary and other diseases.
  • 9. Clinical Findings • Signs of volume depletion(dry mucous membrane,tounge may be dry,sunken eyes,decreased skin turgor,low Blood pressure,dizziness). • Ketosis. • BLOOD WORK: -Thyroid hormones. -Liver enzymes. -Blood urea nitrogen/creatinine. -Bilirubin level. -Amylase,lipase,calcium levels. Imaging: USG to assess for gestational trophoblastic disease, multiple gestations. Flexible endoscopy can exclude upper gastrointestinal cause of vomiting and the procedure is said to be safe during pregnancy.
  • 10. How to Manage? • Hospital admission • Rest reassurance • Correction of fluid • Electrolyte balance by intravenous supplement therapy and repeated testing. • Vitamin supplement(thiamine: due to Wernicke’s encephalopathy) • Drug therapy: anti-emetics(meclozine, promethazine, metoclopramide).
  • 11. • Intravenous dimenhydrinate 50 mg every four to six hours, metoclopramide 5 to 10 mg every eight hours, or promethazine 12.5 to 25 mg every four to six hours transdermal scopolamine may be used. • Patient initially kept fasting and on intravenous therapy until she is well hydrated and the electrolytes are corrected. • Oral food. Small but frequent meal rather than full three time meals a day. • Diet containing carbohydrates and low fat is often tolerated well. • Advised the patient to keep her head side up and take frequent small meals to avoid gastroesophageal reflux.
  • 12. Management of Vomiting ‫ھوالشافی‬ 1 ‫اناریں‬ ‫جوارش‬ ‫۔‬ 7 ‫زرشک‬ ‫شیرہ‬ ‫سے‬ ‫اوپر‬،‫دیں‬ ‫کھال‬ ‫پہلے‬ ‫ماشہ‬ 3 ‫شیرہ‬ ،‫ماشہ‬ ‫خشک‬ ‫پودینہ‬ 3 ‫بخارا‬ ‫آلو‬ ‫شیرہ‬،‫ماشہ‬ 5 ‫بادیان‬ ‫عرق‬،‫دانہ‬ 12 ‫کر‬ ‫نکال‬ ‫میں‬ ‫تولہ‬ ‫غورہ‬ ‫شربت‬ 2 ‫دیں۔‬ ‫کرکے‬ ‫شامل‬ ‫تولہ‬ 2 ‫االئچی‬ ‫دانہ‬،‫سرخ‬ ‫گل‬،‫السوس‬ ‫اصل‬،‫کیلیے‬ ‫روکنے‬ ‫کو‬ ‫قے‬ ‫بعد‬ ‫کے‬ ‫کھانے‬ ‫۔‬ ‫ایک‬ ‫ہر‬ ‫خشک‬ ‫آملہ‬،‫خرد‬ 5 ‫خشک‬ ‫ماشہ۔کنیز‬ 7 ‫سفوف‬ ‫کر‬ ‫چھان‬ ‫کوٹ‬ ‫ماشہ‬ ‫بنائیں۔‬ 6 ‫کھالئیں۔‬ ‫ہمراہ‬ ‫کے‬ ‫پانی‬ ‫سفوف‬ ‫ماشہ‬ ، 3 ‫۔‬ ‫حب‬ ‫تنکار‬ ، ‫گیسٹوفل۔‬
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  • 15. Management of Thiamine deficiency Prompt administration of parenteral thiamine is indicated. The recommended dose is 50 mg given intravenously or intramuscularly for several days. The duration of therapy depends on the symptoms, and therapy is indicated until all symptoms have disappeared. Diet: -Fortified breakfast cereals. -Fish. -Beans, lentils. -Green peas. -Enriched cereals, breads, noodles, rice. -Sunflower seeds. -Yogurt.