Supervised by :

dr. Pim Gonta, Sp. OG

Presented by :
Parmadi Komalajaya 2010-061-168
Kristinova Chandra Dewi 2011-061-082
Fabian Jaya Junaidi 2011-061-084



Nausea
Vomiting
Hiperemesis
Gravidarum

unknown
HCG
estradiol
The peak incidence is at 8-12 weeks of pregnancy, and
symptoms usually resolve by week 20 in all but 10% of
patients.
Hyperemesis is the second leading cause of hospitalization in
pregnancy, second only to preterm labor.
Patients younger than 30 years are more likely to experience
hyperemesis.
Grade 1
Grade
2
Grade
3
Findings at physical examination (usually at the 1
st
trimester) may
include the following :
1. Nausea & vomiting
2. Weight loss
3. Dehydration decreased skin turgor
4. Postural changes in blood pressure (BP) and pulse
Laboratory : Hemoglobin and Hematocrit, hyponatremia,
hypokalemia, proteinuria, ketonuria
1
st
-line treatment : rest and avoidance of sensory stimuli
1. Replace fluids and administer antiemetics
2. Consider the addition of glucose, multivitamins, magnesium,
and/or thiamine.
3. Dextrose solutions may stop fat breakdown.
4. Continue treatment until the patient can tolerate oral fluids and
until test results show little or no ketones in the urine.
5. Frequent small meals

1st-line treatment : Vit. B
1
, B
2
, B
6
, 50-100 mg/day (drip)

Vit B
12
200 g/day (drip), Vit. C 200 mg/day (drip)
Antiemetics
Ondansetron (Zofran)
Starting dosage : 4 mg, either IV or PO, and repeated every 15-30 minutes
Other antiemetics : promethazine 2-3 x 25 mg daily IV / PO or
prochlorperazine 3 x 3 mg daily PO
Antacid : 3 x 1 tab PO
Dopamine-agonists : Metoclopramide, Domperidone
Corticosteroids combined with Ondansentron

Admit pregnant patients with any of the following :
1. Persistently abnormal vital signs
2. Severe dehydration and inability to tolerate oral fluids
3. Severe electrolyte abnormality
4. Acidosis
5. Infection
6. Malnutrition
7. Weight loss

Complications of vomiting rarely occur.
Women with hyperemesis and poor weight gain have lower average birth
weights and are more likely to have a small for gestational age infant and
may be at higher risk for preterm birth.
Without thiamine supplementation, Wernicke encephalopathy may occur
(ie, diplopia, nystagmus, disorientation, confusion, coma).
If treatment is unsuccessful, complications of prolonged dehydration and
starvation may occur.

Women who gained less than 7 kg in pregnancy were more likely
to have fetal complications, but those with hyperemesis and greater
than 7 kg weight gain had no increased risk.
This research indicates that treating hyperemesis gravidarum such
that the patient is able to gain weight portends a better prognosis.