Hyperemis gravidarum

HEG IN PREGNANCY

1. HYPEREMESIS GRAVIDARUM By Mrs.Jasmi Manu Head of the department(OBS/GYN) Nursing Rama college of Nursing Rama University, Kanpur 1 jasmi manu

2. introduction The gastro intestinal tract is commonly affected by the physiologic changes that occur in pregnancy. Nausea and vomiting is common experience. Affecting 50- 90 percent of all women. It is mainly seen in first trimester. 20 percent of the pregnant women symptoms continue throughout pregnancy. 2 jasmi manu

3. Nausea and vomiting in pregnancy is extremely common. Nausea and vomiting occurs in 50-90% of pregnancies. Hyperemesis gravidarum (HEG) is the most severe form of nausea and vomiting in pregnancy Usually occurs with the first pregnancy and commonly affects pregnant women with conditions, such as hydatidiform mole or multiple pregnancy, that produce a high level of human chorionic gonadotropin . 3 jasmi manu

4. Meaning Hyper emesis gravidarum is the most severe manifestation in pregnancy Historically known as “pernicious vomiting of pregnancy”. It is characterized by intractable nausea and vomiting ,so severe as to cause dehydration ,electrolyte and metabolic disturbances and nutritional deficiencies necessitating hospitalization . 4 jasmi manu

5. Definition:- It is a severe type of vomiting of pregnancy which has got deleterious effect on the health of the mother and/or incapacitates her in day to day activities. 5 jasmi manu

6. INCIDENCE Hyperemesis gravidarum has an incidence of ONE in 1000 pregnanies . 6 jasmi manu

7. causes Etiology is obscure But the following are the known facts limited to first trimester More common in first pregnancy Familial history Its is more prevalent in hydatidiform mole and multiple pregnancy More common in unplanned pregnancies 7 jasmi manu

8. Theories Hormonal (^sed HCG,^ Progesterone, Psychogenic Dietetic deficiency(def.vit B6 ,B1 and proteins, disturbances of CHO metabolism) Allergic or immunological basis Decreased gastric motility 8 jasmi manu

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10. PATHOLGY NO specific morbid anatomical findings Changes in various organs due to starvation and severe malnutrition LIVER :-There is centrilobular fatty infiltration without necrosis KIDNEYS :- Occasionally fatty changes in the cells may be related to acidosis HEART :- may be subendocardial hemorrhage BRAIN:- small hemorrhages in hypothalamic region ,lesions due to vitaminB1 deficiencies 10 jasmi manu

11. Metabolic changes Inadequate intake of food results in glycogen depletion. 11 jasmi manu

12. Bio chemical changes 12 jasmi manu

13. Circulatory 13 jasmi manu

14. Clinical features Symptoms of hyperemesis gravidarum Excessive vomiting Epigastric pain Giddiness Oliguria Loss of body weight Dehydration Rapid pulse and low blood pressure Acidosis due to starvation Electrolyte imbalances 14 jasmi manu

15. Signs of hyperemesis gravidarum On general examination Anxious appearance Weight loss Sunken eyes Loss of skin elasticity Dry tongue with ketotic odour of breath Tachycardia Hypotension Fever Rarely,Icterus 15 jasmi manu

16. complications wernicke`s encephalopathy Korsakoff`s psychosis Peripheral neuritis Opthalmic complications Jaundice due to liver involvement Renal insufficiency Stress ulcer Renal failure,convulsions Delirium ,coma and death 16 jasmi manu

17. Complication for the newborn Pre-term labor Low birth weight Developmental delays Congenital heart disease Skeletal malformations Behavior/emotional problems Pregnancy loss and miscarriage (25% for pregnancies) 17 jasmi manu

18. investigations 1)hematological serum electrolytes BUN Hematocrit Liver function tests 2)Urine analysis Reduced volume Dark color High specific gravity Acidic PH Presence of ketones Diminished or absent chlorides 18 jasmi manu

19. 3) Hormonal 4) ECG-changes of hypocalemia USG for confirmation of pregnancy 19 jasmi manu

20. management PRINCIPLES To control of vomiting To remove the Neurogenic elements To correct the fluids electrolyte imbalances(acidosis /alkalosis) To detect the anxious complications Care of pregnancy 20 jasmi manu

21. HOSPITALISATION FLUIDS DRUGS anti-emetic drugs – phenergan 25 mg/ stemetil 5mg twice/trice daily IM HYDROCORTISONE 100 mg iv ./oral also in severs cases Nutritional support- Vitamin B1 VITAMIN B6 ASCORBIC ACID 100 Mg Vitamin B complex 21 jasmi manu

22. DIET Small palatable meals, at regular interval may help the mother to regain her appetite. At first dry CHO foods like biscuits , bread, and toast are given Remove all the spluttering oil smells ,frying smells from the mother Serve food in a pleasant manner,B6,b12,vit c rich diet PLACE OF TERMINATION In case of jaundice, persistent albumiuria ,and poly neurit is, or to prevent maternal mortality 22 jasmi manu

23. The amount of fluids to be administered is calculated as follows Total amount of fluids approximates 3 litters of which half is 5% dextrose and half is ringer’s solution. Extra amount of 5% is dextrose equal to the amount of vomitus and urine in 24 hours.

24. DRGUS Antiemetic drugs Promethazine ( phinergan ) 25 mg. Prochlorperazine 5mg Trifluoperazine 1mg twice a day Administered twice or thrice IM Vit-B6 is also effective Metochlopramide Hydrocortisone 100mg IV

25. Nutritional support Vit-B1 Vit - B6 Vit - C Vit - B12

26. NURSING DIAGNOSIS 1. Risk for deficient fluid volume r/t excessive gastric losses and reduced intake 2. Imbalanced nutrition: less than body requirements r/t inability to ingest/digest/absorb nutrients (prolonged vomiting) 3. Fatigue may be r/t muscle weakness 4. Risk for ineffective coping r/t stress of pregnancy and illness 5. Fear and anxiety r/t concerns for fetal well-being

27. 1. Risk for deficient fluid volume r/t excessive gastric losses and reduced intake. Maintain I.V. fluids, as ordered, until the patient can tolerate oral feedings. Maintain NPO status until vomiting stopped. Monitor fluid intake and output, vital signs, weight, serum electrolyte levels, and urine for ketones. Medicate with antiemetic as prescribed.

28. 2.Imbalanced nutrition: less than body requirements r/t inability to ingest/digest/absorb nutrients (prolonged vomiting) Suggest liquid intake during meals. Advise woman that oral intake can be restarted when emesis has stopped. Company and diversionary conversation at mealtime may be beneficial. Instruct the patient to remain upright for 45 minutes after eating to decrease reflux.

29. 3. Fatigue r/t muscle weakness Teach the patient protective measures to conserve energy and promote rest. Teach relaxation techniques; fresh air and moderate exercise, if tolerated. Schedule activities to prevent fatigue.

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