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In The Name of God

In The Name of God. Vajiheh Marsoosi , M.D Associate Prof. of TUMS Dr. Shariati Hospital. Hyperemesis Gravidarum. Definition. Nausea and vomiting severe enough to produce: Weight loss Dehydration Ketosis Alkalosis from loss of hydrochloric acid Hypokalemia

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In The Name of God

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  1. In The Name of God

  2. VajihehMarsoosi, M.D Associate Prof. of TUMS Dr. Shariati Hospital HyperemesisGravidarum

  3. Definition • Nausea and vomiting severe enough to produce: • Weight loss • Dehydration • Ketosis • Alkalosis from loss of hydrochloric acid • Hypokalemia • Acidosis develops from partial starvation • In some women hepatic dysfunction develops, and there is accumulation of biliary sludge

  4. Etiopathogenesis • High rapidly rising serum levels of pregnancy- related hormones: HCG, estrogens, progestrone, leptin, placental growth factor, prolactin, thyroxine, adrenocortical hormones. • Psychological components • Hyperthyroidism • Previous molar pregnancy • Diabetes • Gastrointestinal illnesses • Some restrictive diets • Asthma and other allergic disorders • Female fetus • Association with preterm labor, placental abruption, and preeclampsia

  5. Complications • Acute Kidney injury-may require dialysis • Depression- cause versus effect? • Diaphragmatic rupture • Esophageal rupture • Hypoprothrombinemia-vitamin K deficiency • Hyperalimentation complications • Mallory –Weiss tears- bleeding, pneumothorax, pneumomediastinum, pneumopericardium • Wernicke encephalopathy-thiamine deficiency

  6. Mineral and Vitamin deficiencies • Zinc↑, Copper ↓, Vitamin B1↓( Wernicke encephalopathy), vitamin K↓( maternal coagulopathy, and fetal intracranial hemorrhage)

  7. Management Mild: • Dietary management: • Ginger extract, • Vitamin B6 plus, • Doxylamine, • Diphenhydramine, or • Dimenhydrinate.

  8. Moderate • Promethazine, • Prochlorperazine, • Trimethobenzamide, • Chlorpromazine, • Metoclopramide, or • Ondansetron • (oral, rectal, parentral)

  9. Severe • Intravenous hydration with thiamine; • Parenteral: • Metoclopramide, • Prometazine, or • Ondansetron

  10. Intractable • Entral or parentral nutrition

  11. Thank You

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