HYPEREMESIS GRAVIDARUM Hyperemesis Gravidarum is excessive nausea and vomiting during pregnancy. This pernicious vomiting is differentiated from the more common and more normal morning sickness by the fact that it is of greater intensity and extends beyond the first trimester. Hyperemesis gravidarum may occur in any of the three trimesters. It is a condition affecting one in 1,000 pregnancies. Hyperemesis gravidarum is a complication of pregnancy that is characterized by severe nausea and vomiting such that weight loss occur. The exact cause of hyperemesis gravidarum is not known. Risk factors include the first pregnancy, multiple pregnancy, obesity or family history of hyperemesis gravidarum. DEFINITION Hyperemesis Gravidarum is defined as extreme, excessive, and persistent vomiting in early pregnancy that may lead to dehydration and malnutrition. INCIDENCE- There has been marked fall in the incidence during the last 30years. It is now a rarity in hospital practice ( less than 1 in 1000 pregnancies). (a)Better application of family planning knowledge which reduces the number of unplanned pregnancies,(b) Early visit to the antenatal clinic and (c) Potent antihistaminic, antiemetic drugs. THEORY • Endocrine theory :high levels of hCG & estrogen during pregnancy • Metabolic theory :vitamin B6 deficiency • Psychological theory : Psychological stress increase the symptoms CLINICAL MANIFESTATION- From the management and prognostic point of view the clinical manifestation divided in to two types- • EARLY • LATE (moderate to severe) 1)Early- Vomiting occurs throughout the day. Normal day to day activities are curtailed. There is no evidence of dehydration or starvation. 2)late-(Evidence of dehydration and starvation are present). o Tachycardia. o Hypotension. o Rise in temperature. o Poor appetite. o Poor nutritional intake. o Loss of more than 25% of body weight. o Dehydration and electrolyte imbalance. o Rapid pulse and low blood pressure. o Occasionally, jaundice develops in severe cases. DIAGNOSTIC EVALUATION- • Opthalmoscopic examination: Required if the patient is seriously ill. Retinal hemorrhage and detachment of the retina are the most unfavorable signs. • ECG: When there is abnormal serum potassium level. COMPLICATION  Weight loss  Dehydration  Metabolic acidosis from starvation  Hypokalemia (electrolyte imbalance) MANAGEMENT- Women with hyperemesis gravidarum are admitted to the hospital. Initially nothing is given by mouth. Hypovolemia and electrolyte imbalance are corrected by intravenous infusion. Vitamin supplements are given parenterally. Fluids and diet are gradually introduced as the woman’s condition improves. principles of management : • To control vomiting. • To correct the fluids and electrolytes imbalance. • To correct metabolic disturbances(acidosis or alkalosis). • To prevent the serious complications of severe vomiting. Hospitalization-

1. TOPIC PRESENTATION
ON
PERNICIOUS VOMITING
 PRESENTED BY:-
RATNA PARMAR
NURSING OFFICER
MGMCC

2. HYPEREMESIS GRAVIDARUM
 Hyperemesis Gravidarum is excessive nausea and vomiting
during pregnancy.
 This pernicious vomiting is differentiated from the more
common and more normal morning sickness by the fact that it
is of greater intensity and extends beyond the first trimester.
 Hyperemesis gravidarum may occur in any of the three
trimesters. It is a condition affecting one in 1,000
pregnancies.
 Hyperemesis gravidarum is a complication of pregnancy that
is characterized by severe nausea and vomiting such that
weight loss occur. The exact cause of hyperemesis
gravidarum is not known. Risk factors include the first
pregnancy, multiple pregnancy, obesity or family history of
hyperemesis gravidarum.

3. DEFINITION
 Hyperemesis Gravidarum is defined as extreme,
excessive, and persistent vomiting in early
pregnancy that may lead to dehydration and
malnutrition.

4. INCIDENCE-
 There has been marked fall in the incidence during the
last 30years. It is now a rarity in hospital practice ( less
than 1 in 1000 pregnancies). (a)Better application of
family planning knowledge which reduces the number of
unplanned pregnancies,(b) Early visit to the antenatal
clinic and (c) Potent antihistaminic, antiemetic drugs.

5. THEORY
• Endocrine theory :high levels of hCG & estrogen
during pregnancy
• Metabolic theory :vitamin B6 deficiency
• Psychological theory : Psychological stress
increase the symptoms

6. CLINICAL MANIFESTATION-
 From the management and prognostic point of view the clinical
manifestation divided in to two types-
 EARLY
 LATE (moderate to severe)
 1)Early- Vomiting occurs throughout the day. Normal day to day
activities are curtailed. There is no evidence of dehydration or
starvation.
 2)late-(Evidence of dehydration and starvation are present).

7. o Increased vomiting.
o Urine quantity is diminished.
o Epigastric pain.
o Constipation.
o Dry coated tongue.
o Sunken eyes.

8. o Tachycardia.
o Hypotension.
o Rise in temperature.
o Poor appetite.
o Poor nutritional intake.

9. o Loss of more than 25% of body weight.
o Dehydration and electrolyte imbalance.
o Rapid pulse and low blood pressure.
o Occasionally, jaundice develops in severe
cases.

10. DIAGNOSTIC EVALUATION-
 Urinalysis: (1) Quantity- small (2)Darkcolour (3) High
specific gravity with acid reaction (4)Presence of
acetone, occasional presence of protein andrarely bile
pigments
(5) Diminished or even absence of chloride.
 Biochemical and circulatory changes: The
changes are mentioned previously. Routine and
periodic estimation of the serum electrolyte (sodium,
potassium and chloride) is helpful in the management
of the case.

11.  Opthalmoscopic examination: Required if the
patient is seriously ill. Retinal hemorrhage and
detachment of the retina are the most
unfavorable signs.
 ECG: When there is abnormal serum potassium
level.

12. COMPLICATION
 Weight loss
 Dehydration
 Metabolic acidosis from starvation
 Hypokalemia (electrolyte imbalance)

13. MANAGEMENT-
Women with hyperemesis gravidarum are admitted
to the hospital. Initially nothing is given by mouth.
Hypovolemia and electrolyte imbalance are
corrected by intravenous infusion. Vitamin
supplements are given parenterally. Fluids and diet
are gradually introduced as the woman’s condition
improves.

14.  principles of management :
 To control vomiting.
 To correct the fluids and electrolytes imbalance.
 To correct metabolic disturbances(acidosis or
alkalosis).
 To prevent the serious complications of severe
vomiting.

15.  Hospitalization-
 Whenever a patient is diagnosed as a case of hyperemesis
gravidarum, she is admitted, surprisingly, with the same diet
and drugs used at home, the patient improves rapidly.
 Fluids therapy
Oral feeding is withheld for at least 24 hours after the
cessation of vomiting. During this period, fluid is given
through intravenous drip method. The amount of fluid to be
infused in 24 hours is calculated as follows: the total amount
of fluid approximates 3 litres, of which half is 5% dextrose
and half is Ringer’s solution. Extra amount of 5% dextrose
equal to the amount of vomitus and urine in 24 hours, is to be
added.

16. Drugs-
emetic drugs- Promethazine(Phenergan) 25mg or
Prochlorperazine (stemetil) 5mg or trifluopromazine (siquil)
10mg may be administered twice or thrice daily
intramuscularly. Trifluoperazine (Espazine) 1mg twice daily
intramuscularly is a potent anti-emetic therapy. Vitamin B6
and Doxylamine are also safe and effective.
Metoclopramide stimulates gastric and intestinal motility
without stimulating the secretions. It is found useful.
Hydrocortisone- 100 mg I.V. in the drip is given in a case
with hypotension or in intractable vomiting. Oral method
prednisolone is also used in severe cases.
Nutritional support- with vitamin B1, vit B6, vit C and vit.
B12 are given.

17. ADVICE
Avoid:
Before or after meals: Stuffy rooms, odors (e.g.,
perfume, chemicals, coffee, food, smoke), heat,
humidity, noise, visual or physical motion (e.g.,
flickering lights, driving), being tired.
PREFFERABLE DIET
 Tea and dry biscuit before getting up.
 Eat small frequent meals. Eat something every 2–
3 hours to avoid hunger.
 Drink fewer liquids with meals. Drinking liquids
can cause a full, bloated feeling.

18.  Brushing teeth after eating may help prevent
symptoms.
 Avoid lying down immediately after eating .
 Rest after meals. Sit up in a chair for about an
hour after meals.
 Avoid sudden movements. Rise slowly from the
bed.
After meals

19.  ALTERNATIVE THERAPY
FOR
NAUSEA AND VOMITTING

20. ACUPRESSURE
Acupressure is the stimulation by
pressure on specific called
acupoints.
Relief can be felt in 10-30 seconds,
however, it can take up to five
minutes.

21. P6 WRIST BAND
They are inexpensive and can be
positioned over acupressure points on
both wrists.
Traditional acupuncture should be
performed only under the supervision
of a trained professional.

22. OTHER THERAPY
AROMA THERAPY
DIVERTIONAL THERAPY
SLEEP AND REST
RECREATIONAL THERAPY

23. NURSING DIAGNOSIS
TO control the vomiting.

24. 1. Fluid volume deficit related to
excessive fluid loss as evidenced by
dehydration.
2.Nutrition less than body requirement
related to vomiting as evidenced by weight
loss.

25. Constipation related to changes in
diet(dehydration) and decreased physical
activity as evidenced by client not passes
the stool even one time in a day.
Anxiety related to disease prognosis as
evidenced by facial tension.

26. NURSING MANAGEMENT-
 1. Need for maintaining fluid volume
 2. Need for reduce pain
 3. Need for prevent from infection
 4. Need for reducing anxiety

27. CONCLUSION-
Many women experience morning sickness, or
nausea, during pregnancy. This condition is
generally harmless. While morning sickness can be
quite uncomfortable, it typically goes away within
12 weeks. Hyperemesis gravidarum (HG) is an
extreme form of morning sickness that causes
severe nausea and vomiting during pregnancy. The
symptoms of HG begin within the first six weeks of
pregnancy, and nausea often doesn’t go away. HG
can be extremely debilitating and cause fatigue
that lasts for weeks or months.

28. ASSIGNMENT
WRITE IN BRIEF WHAT HEALTH EDUCATION
WILL YOU PROVIDE MOTHER SUFFERING
FROM HYPEREMESIS GRAVIDERUM AND
SUBMITTED ON 22/06/2017.