HYPEREMESIS

GRAVIDARUM

PRESENTED BY –
ASHA S MARIHAL
2ND YEAR M.Sc NURSING
20NPG003
DEPT. OF OBG
SDMIONS
 TOPICS TO BE
COVERED
1. Definition
2. Incidence
3. Risk factors

. 4. Theories
5. Clinical coarse
6. Clinical features
7. Investigations
8. Management
9. Nursing care
10. Complications.
 DEFINITION

It is a severe type of vomiting in pregnancy which got

deleterious effects on the health of the mother or
incapacities her in day today life.

INCIDENCE

• There has been marked fall in the incidence during last 30

years.
• Less than 1 in 1000 pregnancies
 RISK FACTORS

• Hyperemesis gravidarum is more common in

1. Trophoblastic diseases
2. Multiple pregnancies
3. Those who have h/o hyperemesis gravidarum in
previous pregnancy.
4. Nulliparity
5. Female fetus
6. Maternal obesity
7. Age <30 years
8. Smoking
 CLINICAL COARSE

EARLY LATE
Vomitting occurs
Evidence of
throughtout the day,
dehydration and
normal day to day
starvation present.
activities are done.

There is no evidence
of dehydration and
starvation present
 CLINICAL FEATURE

SIGNS: SYMPTOMS:
1. Dehydration 8. Nausea
2. Muscle wasting 9. Vomitting
3. Ketosis 10. Ptyalism
4. Weight loss 11. Spitting
5. Postural hypotension 12. Fatigue
6. Tachycardia 13. Anorexia
7. Collapse
 INVESTIGATIONS
Urine analysis
-Small Quantity
-Dark colour
-High specific gravity with acid reaction
-Presence of acetone
-Diminished or absence of chloride.

Biochemical and circulatory changes

-Raised haematocrit
-Raised blood urea and creatinine
-Electrolyte imbalance (hyponatremia, hypokalemia, hypochloremia)
-Abnormal liver function test (raised)
-Serum amylase lipase may be high.
Ophthalmic Examination
-In severe cases, retinal haemorrhage and detachment of the
retina are the most unfavourable sign.

ECG
-when there is abnormal serum potassium level (hypokalemia)

Differential diagnosis
-Liver dysfunction
-Peptic ulceration
-Severe gastroesophageal reflux
-Psychological problem
 MANAGEMENT

• The principle of management

1. To control vomittng

2. To correct the fluid electrolyte imbalance.

3. To correct metabolic disturbance (acidosis or alkalosis).

4. To prevent serious complication of severe vomiting.

5. Care of pregnancy.
HOSPITALIZATION
- Whenever a patientis diagnosed with hyperemesis
gravidarum, she is admitted.

FLUIDS
- Oral feeding is withheld for at least 24 hours, after the
cessation of vomiting.
- During this period, intravenous fluid are administered.
- The amount of fluid administered in 24 hours is calculated
as follows
 Total amount of fluid to be administered

3 litres

1.5 litres 1.5 litres

5% Dextrose Ringer’s solution

The extra amount of 5% Dextrose equal to the amount of

vomitus and urine in 24 hours is to be added.

With this regime- dehydration, ketoacidosis, water &

electrolyte imbalance are likely to be rectified.
• DRUGS:
- Antiemetic drug : promethazine (Phenergan) 25mg
or prochlorperazine (stemetil) 5mg may
administered twice or thrice a day, daily
intramuscularly.
- Trifluoperazine (espazine) 1mg twice daily IM is
a potene antiemetic therapy vitamin B6 and
doxylamine are also safe and effective
- Metoclopramide : It stimulate gastric& intestinal
motility without stimulating the secretion. It is
found to be useful.
- Hydrocortisone: 100mg IV in a drip is given in case
of hypotension or in intractable vomiting, oral
method prednisolone is also used in severe cases.

NUTRITIONAL SUPPORT

- With vitamin B1, vitamin B6, vitamin C, vitamin

B12 are given .
 NURSING CARE

- Sympathetic but firm handling of the patient is essential.

- Social and psychological support should be extended

- Monitoring vital signs every 4th hourly

- Maintaining intake- output chart

- Monitoring urine analysis, blood biochemistry investigation.

- ECG (In case of Hypokalemia ).

• DIET:

- Before the IV fluids are omitted, food is given orally.

- At first, dry carbohydrates food like BRATT diet is given.

(BRATT- Banana, Rice, Applesause, Tea and Toast)

- Small but frequent feed are recommended.

- Advice patient to sit in upright position after having meals

- Gradually fully diet is restored.

Clinical feature of improvement are evidenced by-

1. Subsidence of vomiting

2. Feeling hunger

3. Better look

4. Disappearance of acetone in blood and urine

5. Normal pulse and blood pressure

6. Normal urine output.

 COMPLICATIONS

1. Neurological complication :

- Wernicke’s encephalopathy due to thiamine deficiency.

- Pontine myelinolysis

- Peripheral neuritis

- Korsakoff's psychosis

2. Stress ulcer in stomach

3. Oesophageal tear.
4. Jaundice

5. Convulsion

6. Coma

7. Renal failure
ANY QUESTIONS ?
THANK YOU