Hiperemesis

Gravidarum (HP)
  Keadaan mual dan muntah yang dialami
hingga mengganggu aktivitas sehari-hari
Hiperemesis hingga menimbulkan komplikasi dehidrasi,
gravidarum hipokalemia dan penurunan berat badan lebih
dari 3 kg atau 5% dari berat badan sebelum
hamil
 hormon kehamilan bisa menyebabkan HG

Teori

kadar hormon yang lebih tinggi selama awal

kehamilan

HCG, Progesteron, estrogen, hormone tiroid , leptin,

corteks adrenal, growth hormone etc…
  Dehidrasi
Manifestasi  Gangguan metabolic dan
 Gangguan elektrolit
 Hubungan
persarafan
pusat muntah,
beberapa inti
sensorik,
motorik dan
kontrol
 Pathway interaksi
-endokrin, organ
target, dan fungsi
hiperemesis
gravidarum

LESP : lower esophageal sphincter pressure

ACTH : adrenocorticotropic hormone
Pathway HG
Maternal Complikasi:
1. Psychological impacts:
50.5% of pregnant women with HG were found to have psychiatric
troubles. The severity of is correlated with social anxiety, sleep disorders
and severe depression
2. Nutrisi defisiecy
3. Wernicke encephalopathy
can be precipitated by carbohydrate-rich food but it commonly occurs in
cases of thiamine y who received glucose infusions without thiamine
replacement which deteriorates the biochemical status of thiamine
4. Electrolyte imbalance and metabolic disturbances ,ect
Fetal Complikasi
 Abnormal plasenta
Axis - Leptin -
Energy
 Interaksi antara adipokin dan
reproduksi wanita

Adipokines: implications for female fertility and

obesity M Mitchell, D T Armstrong, R L Robker and
R J Norman, 2005
 Leptin – pregnancy
disorder

Leptin action in normal and pathological

pregnancies
Antonio perez, et al., 2018

polycystic ovary syndrome (PCOS), recurrent miscarriage

(RM), gestational diabetes mellitus (GDM), pre-eclampsia
(PE) and intrauterine growth restriction (IUGR).
Evaluation of Nausea and Vomiting During Pregnancy
 Pregnancy-
Unique
Quantification
of Emesis
(PUQE) index
 Algoritm
Treatmen NVP
dan HG
 Rekomendasi antiemetik

First line ● Cyclizine 50 mg PO, IM or IV 8 hourly

● Prochlorperazine 5–10 mg 6–8 hourly PO; 12.5 mg 8 hourly IM/IV; 25 mg
PR daily
● Promethazine 12.5–25 mg 4–8 hourly PO, IM, IV or PR
● Chlorpromazine 10–25 mg 4–6 hourly PO, IV or IM; or 50–100 mg 6–8
hourly P
Second line  Metoclopramide 5–10 mg 8 hourly PO, IV or IM (maximum 5 days’ duration)
 Domperidone 10 mg 8 hourly PO; 30–60 mg 8 hourly PR
 Ondansetron 4–8 mg 6–8 hourly PO; 8 mg over 15 minutes 12 hourly IV

Third line ● Corticosteroids: hydrocortisone 100 mg twice daily IV and once clinical improvement occurs,
convert to prednisolone 40–50 mg daily PO, with the dose gradually tapered until the lowest
maintenance dose that controls the symptoms is reached

IM intramuscular; IV intravenous; PO by mouth; PR by rectum .

Terapi HG
Multimodal character of treatment strategies in hyperemesis gravidarum
TERIMA KASIH