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HYPEREMESIS GRAVIDARUM

HYPEREMESIS GRAVIDARUM. DEFINITION. It is a sever type of vomiting which has got deleterious effect on the health of the mother and/or incapacitates her in day-to-day activities. EFFECTS OF SEVERE VOMITING. Dehydration Metabolic acidosis (from starvation)

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HYPEREMESIS GRAVIDARUM

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  1. HYPEREMESIS GRAVIDARUM

  2. DEFINITION • It is a sever type of vomiting which has got deleterious effect on the health of the mother and/or incapacitates her in day-to-day activities

  3. EFFECTS OF SEVERE VOMITING • Dehydration • Metabolic acidosis (from starvation) • Alkalosis (from loss of hydrochloric acid) • Electrolyte imbalance • Weight loss

  4. INCIDENCE • Less than 1 in 1000 pregnancies • Marked reduction in the incidence

  5. ETIOLOGY • Mostly limited to the first trimester • More common in first pregnancy with a tendency to recur • Has got familial history • More prevalent in hydatidiform mole and multiple pregnancy • More common in unplanned pregnancies • Less among illegitimate ones

  6. THEORIES • HORMONAL • Increased HCG • High serum level of estrogen • Excess progesterone • Thyroxin,prolactin and Adrenocortical hormone • PSYCHOGENIC • DIETETIC DEFICIENCY • Vitamin B6,B1 • ALLERGIC • IMMUNOLOGICAL BASIS • DECREASED GASTRIC MOTILITY

  7. PATHOLOGY • LIVER – Centrilobular fatty infiltration without necrosis • KIDNEY – Fatty changes in the cells of convoluted tubule • HEART – Subendocardial hemorrhage • Brain – Wernicke’s encephalopathy

  8. METABOLIC CHANGES • Inadequate intake of food • Glycogen depletion • Fat reserve is broken down • Inadequate oxidation of fat • Accumulation of ketone bodies • Acetone excreted through breath and kidney

  9. METABOLIC CHANGES….Contd • Increase in endogenous tissue protein metabolism • Excessive excretion of non – protein nitrogen in the urine

  10. CIRCULATORY CHANGES • Fall in plasma sodium,pottasium and chlorides • Acidosis and ketosis • Rise in blood urea and uric acid • Hypoglycemia • Hypoproteinemia • Hypovitaminosis • Hyperbilirubinemia

  11. BIOCHEMICAL CHANGES Haemoconcentration Rise in hemoglobin percentage Rise in RBC count Rice in haematocrit value

  12. CLINICAL MANIFESTATION For the purpose of management the cases are grouped into: • EARLY • LATE

  13. CLINICAL MANIFESTATION….Contd EARLY • Vomiting occurs throughout the day • Normal day to day activities are curtailed • No evidence of dehydration and starvation

  14. CLINICAL MANIFESTATION….Contd LATE SYMPTOMS • Vomiting increase in frequency • Retching • Urine quantity diminished to the extend of oliguria • Epigastric pain • Constipation

  15. CLINICAL MANIFESTATION….Contd LATE SIGNS Features of dehydration and ketosis • Dry coated tongue • Sunken eye • Acetone smell in breath • Tachycardia • Hypotension • Rise in temperature • Jaundice is a late sign

  16. INVESTIGATIONS • URINALYSIS • Quantity – Small • Dark colour • High specific gravity • Presence of acetone and rarely protein • Dimnished or absence of • BIOCHEMICAL AND CIRCULATORY CHANGES • OPHTHALMIC EXAMINATION • Retinal haemorrhage and detachment of retina • ECG

  17. DIAGNOSIS • Pregnancy is to be confirmed first • USG

  18. COMPLICATIONS • Neurologic complications • Wernicke’s encephalopathy • Pontine myelinolysis • Peripheral neuritis • Korsakoff’s psychosis • Stress ulcers in the stomach • Esophageal tear • Jaundice • Convulsions and coma • Renal failure

  19. MANAGEMENT PRINCIPLES • To control vomiting • To correct fluid and electrolyte imbalance • To correct metabolic disturbances • To prevent serious complications

  20. MANAGEMENT…..Contd • HOSPITALISATION • FLUIDS • NPO status • IV Fluids • 3 liters of which Half is 5% dextrose and Half is RL • DRUGS • Antiemetic • Promethazine 25mg • Prochlorperazine 5mg • Trifluopromazine10mg • Hydrocortisone 100mg IV • Nutritional support • DIET

  21. NURSING CARE HYPEREMESIS PROGRESS CHART • Pulse • Temperature • Blood pressure • Intake-output • Urine for acetone,protein,bile • Blood biochemistry • ECG

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