Hyperemesis gravidarum is a severe form of vomiting during pregnancy that can negatively impact the health of the mother and her ability to perform daily activities. It is caused by high levels of hormones like HCG and estrogen, as well as potential dietary deficiencies, genetic factors, and liver or vestibular system dysfunction. Clinically, it presents with dehydration, ketoacidosis, and metabolic changes. Investigations show hematological and biochemical abnormalities. Complications include Wernicke's encephalopathy and esophageal rupture. Management focuses on controlling vomiting, correcting fluid and electrolyte imbalances, treating metabolic disturbances, and preventing complications, while continuing prenatal care. Treatment involves IV fluids, antiemet

1. Dr.Sunanda

2.  DEFINITION
 ETIOLOGY
 PATHOLOGY
 CLINICAL FEATURES
 INVESTIGATIONS
 COMPLICATIONS
 MANAGEMENT

3.  Severe type of vomiting of pregnancy which has
got deleterious effect on the health of the mother
&/or incapacitates her in day to day activities.

4.  Hormonal-
1. higher HCG level- twins, GTT
2. higher oestrogen level
3. progesterone excess -relaxation of cardiac sphincter & impaired
gastric motility
 Dietary deficiency-low carbohydrate intake, vit B6,B1
deficiency
 Psychogenic
 Genetic
 Allergic or immunological basis
 Liver dysfunction
 Vestibular system dysfunction

5.  Metabolic changes-
Glycogen depletion- incomplete oxidation of fat-
ketone bodies
 Biochemical-
plasma K, Na, Cl.
acidosis, ketosis,
blood urea, uric acid
 Circulatory-
haemoconcentration- rise in Hb,RBC count,
haematocrit

6.  Early-no evidence of dehydration or starvation
 Late-evidence of dehydration or starvation

7.  Features of dehydration and ketoacidosis-
• dry coated tongue,
• sunken eyes,
• acetone smell in the breath
• tachycardia,
• hypotension
• Rise in temperature,
• Jaundice

8.  Haematological & biochemical changes
 Urinanlysis
• dark coloured, oliguria, acidic PH
• high specific gravity with acid reaction
• presence of ketones
• Diminished or absent chlorides
 Serum electrolytes
 Ophthalmoscopic examination-retinal haemorrhages &
detachment
 ECG-when there is hypokalemia

9.  Neurological-
1. Wernicke encephalopathy—thiamine deficiency
2. Korsakoff’s psychosis
3. Peripheral neuritis
4. Pontine myelinolysis
 Esophageal rupture—Boerhaave syndrome
 Oesophageal tear- Mallory -Weiss syndrome
 Stress ulcer in stomach,
 Renal failure, convulsions,coma

10. PRINCIPLES IN MANAGEMENT
 To control vomiting
 To correct fluids & electrolyte imbalance
 To correct metabolic disturbances
 To prevent the serious complications of severe
vomiting
 Care of pregnancy

11. FLUIDS
 Withold oral fluids for 24hrs after cessation of
vomiting
 IV fluids in 24hrs- total 3 litres, half of which is 5%D &
half RL.
 Extra amount of 5%D equal to the amount of vomitus
& urine in 24hrs.
 Correct serum electrolytes

12.  Antiemetics- promethazine(phenergan)
prochlorperazine(stemetil), trifluperazine.
 metoclopramide stimulates gastric and intestinal
motility without stimulating the secretions
 Hydrocortisone 100mg I.V for hypotension or
intractable vomiting.
 Nutritional support-Vit B1,B6,C,B12
 Nursing care, Hyperemesis progress chart.
 Daily record-vitals, I/O chart, urine for acetone, blood
biochemistry, ECG
 Termination of pregnancy rarely indicated.

14. THANK YOU