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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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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) • Alkalosis (from loss of hydrochloric acid) • Electrolyte imbalance • Weight loss
INCIDENCE • Less than 1 in 1000 pregnancies • Marked reduction in the incidence
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
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
PATHOLOGY • LIVER – Centrilobular fatty infiltration without necrosis • KIDNEY – Fatty changes in the cells of convoluted tubule • HEART – Subendocardial hemorrhage • Brain – Wernicke’s encephalopathy
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
METABOLIC CHANGES….Contd • Increase in endogenous tissue protein metabolism • Excessive excretion of non – protein nitrogen in the urine
CIRCULATORY CHANGES • Fall in plasma sodium,pottasium and chlorides • Acidosis and ketosis • Rise in blood urea and uric acid • Hypoglycemia • Hypoproteinemia • Hypovitaminosis • Hyperbilirubinemia
BIOCHEMICAL CHANGES Haemoconcentration Rise in hemoglobin percentage Rise in RBC count Rice in haematocrit value
CLINICAL MANIFESTATION For the purpose of management the cases are grouped into: • EARLY • LATE
CLINICAL MANIFESTATION….Contd EARLY • Vomiting occurs throughout the day • Normal day to day activities are curtailed • No evidence of dehydration and starvation
CLINICAL MANIFESTATION….Contd LATE SYMPTOMS • Vomiting increase in frequency • Retching • Urine quantity diminished to the extend of oliguria • Epigastric pain • Constipation
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
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
DIAGNOSIS • Pregnancy is to be confirmed first • USG
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
MANAGEMENT PRINCIPLES • To control vomiting • To correct fluid and electrolyte imbalance • To correct metabolic disturbances • To prevent serious complications
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
NURSING CARE HYPEREMESIS PROGRESS CHART • Pulse • Temperature • Blood pressure • Intake-output • Urine for acetone,protein,bile • Blood biochemistry • ECG