HYPEREMESIS GRAVIDARUM

This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan

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 DEFINED VARIABLY AS VOMITING SUFFICIENTLY SEVERE TO PRODUCE WEIGHT LOSS, DEHYDRATION, ACIDOSIS FROM STARVATION, ALKALOSIS FROM LOSS OF HCL IN VOMIT & HYPOKALAMIA. ” “ SEVERE VOMITING 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- Trophoblastic disease Multiple pregnancy Nuliperity Female fetus Age > 30year Maternal obesity Smoking Those who had HEG in previous pregnancy Has got familial history

5. THEORIES:- HORMONAL THEORY : excess of HCG & estrogen trigger vomiting centre progesterone excess relaxation of cardiac sphincter retension of gestric fluid. PSYCHOGENIC THEORY: IT PROBABLY AGGRAVATED NAUSEA TRIGGER NEUROGENIC ELEMENTS SOMETIMES TRIGGER

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: URIN ANALYSIS CBC LIVER FUNCTION TEST(LFT) THYROID FUNCTION TEST ULTRASOUND SCAN 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 B 1 , vitamin B 6 , vitamin B 12 & 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- Vomiting doesn’t abote on therapy 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

18. Boerhaave syndrome - characterized by upper gastrointestinal bleeding secondary to transmural perforation of the esophagus COMPLICATIONS

19. MANAGEMENT OF NAUSE AND VOMITING SYMPTOM: Drink & eat little & often. Meal high in CHO & low in fat is better. Cold meals reduce smell related nausea. Avoid caffeine & alcohol as these can enhancer dehydration.

20. THANK YOU