Hyperemesis Gravidarum e.pptx

DETAILS of management of hyperemesis graviderum

1. Definition I ntractable vomiting associated with loss of more than 5% of pre-pregnancy weight dehydration electrolyte disturbances or need for hospital admission

2. Incidence 0.3 – 3.6% High risk of recurrence in subsequent pregnancies

3. Risk factors Young age Primigravidae Multiple pregnancy Molar pregnancy Family history Hyperthyroidism

4. Etiology

5. Differential diagnosis

6. Classification of severity Rhodes index PUQE-24 score – Pregnancy-Unique Quantification of Emesis Objective and validated index Mild: ≤ 6 Moderate: 7- 12 Total 15 Severe: 13 - 15

7. Management

8. History Previous history of hyperemesis gravidarum Quantify severity History to exclude other causes: abdominal pain urinary symptoms infection drug history chronic Helicobacter pylori infection

9. Examination Temperature Pulse Blood pressure Oxygen saturations Respiratory rate Weight Abdominal examination Signs of dehydration Signs of muscle wasting Other examination as guided by history

10. Investigations Complete blood count S. urea and electrolytes Urine routine analysis + urine ketones Blood glucose monitoring (rule out diabetes) Thyroid function tests Liver function tests, including S. Amylase Ultrasound scan

11. Complications

12. Complications… Abnormal thyroid function tests Abnormal liver function tests Pontine demyelination Thrombosis Peripheral neuropathy & megaloblastic anemia Wernicke’s encephalopathy

13. Principles of management Maintain hydration C ontrol vomiting C orrect the fluids and electrolytes imbalance To prevent the complications of severe vomiting Care of pregnancy This Photo by Unknown Author is licensed under CC BY-SA

14. Hospitalization Continued nausea & vomiting + inability to keep down oral antiemetics Continued nausea & vomiting + ketonuria and/ or weight loss (˃5% body weight), despite oral antiemetics Confirmed or suspected comorbidity ( eg. UTI and inability to tolerate oral antibiotics) A t least one of the following

15. Initial management

16. Drugs 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

17. Drugs

18. Normal saline + KCl – best hydration Dextrose containing fluids Can precipitate Wernicke’s encephalopathy High dose thiamine supplementation

19. Intravenous fluids Maintenance fluids Water 25-30 ml/kg/day Na + , K + , Cl - 1 mmol/kg/day Glucose 50-100 gms /day To prevent starvation ketosis

20. Complementary therapies Ginger Acupressure and acupuncture Histamine H2 receptor antagonists (famotidine, cimetidine etc.) Proton pump inhibitors (pantoprazole, omeprazole) Multidisciplinary approach

21. Future pregnancies Risk of recurrence present Early use of lifestyle/dietary modifications and antiemetics, found to be useful in the index pregnancy advisable – to reduce the risk of nausea, vomiting and hyperemesis in the current pregnancy