Hyperemesis gravidarum NEW.pptx pregnancy

About complications during pregnancy

1. HYPEREMESIS GRAVIDARUM PRESENTED BY HANEEN AND HEPHZIBAH

2. It is a severe type of vomiting of pregnancy which has negative effects on the health of the patient and makes day to day activities difficult. HYPEREMESIS : EXCESSIVE VOMITING GRAVIDARUM : PREGNANCY

3. ETIOLOGY ENDOCRINE HCG has been postulated to be the cause. This is probably why hyperemesis is more common in pregnancies with high HCG levels

4. 2. INFECTION Helicobacter pylori is a gram negative bacillus that has been associated with the development of peptic ulcer with similar symptoms. This organism has been isolated in severe hyperemesis

5. 3. UPPER GASTROINTESTINAL DYSMOTILITY Dysmotility due to smooth muscle relaxation is common during pregnancy. This could be a factor contributing to the hyperemesis

6. 4. PSYCHOLOGICAL This is one of the oldest theories postulated in the pathogenesis of hyperemesis

7. 5. OTHER POSTULATES Liver dysfunction Altered lipid metabolism Immunological theory

8. PATHOLOGY 1.METABOLIC CHANGES Starvation causes depletion of glycogen and mobilization of fat. This if prolonged, hypoglycemia, hypoproteinemia and hypervitaminosis can occur.

9. 2. BIOCHEMICAL Vomiting and dehydration can lead to hyponatraemia, hypokalaemia and hypochloraemia. 3. HEMATOLOGICAL Haemoconcentration can also occur.

10. COMPLICATIONS Electrolyte imbalance Liver dysfunction and jaundice Acute renal failure Stress ulcers in the stomach Mallory-Weiss tears in the esophagus Esophageal rupture or Boerhaeve syndrome

11. Pneumothorax and pnemomediastinum Complications due to vitamin deficiency such as Wernicke’s Encephalopathy, Korsakoff psychosis, bleeding disordes etc.. Depression

12. MANAGEMENT SUPPORTIVE TREATMENT Prompt hospitalisation is mandatory to prevent the complications IV Crystalloids are given to correct dehydration, ketosis, electrolyte imbalance and acid base imbalance

13. 2. ANTIEMETICS Antihistamines like doxylamine 10mg orally once or twice a day, alone or in combination with vitamin B6 can be used. Metoclopriamide 10mg orally upto 4 times a day can also be given

14. 3. PYRIDOXINE It has been shown to be effective in the management of nausea in early pregnancy but may not be very effective in intractable vomiting

15. 4. METHYLPREDNISOLONE Its usefulness is controversial. Some studies have shown it to be effective in severe hyperemesis, probably by a direct effect on the vomiting centre of the brain

16. 5. LIFESTYLE AND DIET CHANGES Avoid offensive food and odours, eat small frequent meals with a high protein, low fat, low carbohydrate content and avoid iron supplements

17. 6. ALTERNATIVE THERAPIES Alternative therapies like psychotherapy, acupressure and medical hypnosis can be tried. Combination of supportive treatment, antiemetics and dietary modifications is recommended

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