PRESENTED BY,

Vomiting in early MRS.KAVITHA.P

pregnancy OBG DEPARTMENT
The vomiting is related to the pregnant state and
depending upon the severity,

it is classified as:
I. Simple vomiting of pregnancy or milder type
II. Hyperemesis gravidarum or severe type.
SIMPLE VOMITING (Syn: morning sickness, emesis gravidarum):
The patient complains of nausea and occasional sickness on rising in
the morning.

Management: Assurance is important. Taking of dry toast or biscuit

and avoidance of fatty and spicy foods are enough to relieve the
symptoms in majority.

Promethazine and ondansetron can be used. Patient is advised to take

plenty of fluids (2.5 L in 24 hours) and fruit juice.
 HYPEREMESIS GRAVIDARUM

DEFINITION: It is a severe type of vomiting of pregnancy which has got

deleterious effect on the health of mother and/or incapacitates her in day-
to-day activities. The adverse effects of severe vomiting are—dehydration,
metabolic acidosis (from starvation) or alkalosis (from loss of
hydrochloric acid), electrolyte imbalance (hypokalemia) and weight loss.
 (1) It is mostly limited to the first
trimester;
(2) It is more common in first
pregnancy (15%);
ETIOLOGY: (3) Younger age;
(4) Low body mass
(5) History of motion sickness or
migraine;

Cont…
(6) It has got a familial history — mother and sisters also suffer
from the same manifestation;
(7) It is more prevalent in hydatidiform mole and multiple
pregnancy and
(8) It is more common in unplanned pregnancies
 (1) Hormonal: (a) Excess of chorionic
gonadotropin or higher biological activity of
hCG is associated.

(2) Psychogenic: It probably aggravates the

THEORIES
nausea once it begins. But neurogenic element
sometimes plays a role, as evidenced by its
subsidence after shifting the patient from the
home surroundings.
(3) Dietetic deficiency: Probably due to low
carbohydrate reserve, as it happens after a night
without food.
(4) Allergic or immunological basis.
(5) Decreased gastric motility is found to cause
nausea.
Signs and symptoms

 Pernicious vomiting(anything taken orally is rejected)

 Poor appetite and poor nutritional intake
 Loss of more than 25% of body weight
 Dehydration and electrolyte imbalance
  Urinalysis
• Quantity small
• Dark color
• High specific gravity
• Presence of acetone,protein ,bile pigments
Investigation • Diminishes absence of chloride
 Serum electrolyte
 TSH
 Ophthalmic examination (severe may
cause retinal hemorrhage)
 ECG(if abnormal serum potassium level)
  Circulatory changes
 Jaundice due to liver involvement
 Retinal hemorrhage
 Wernick's encephalopathy
 Korsakoff'
Complication
syndrome(dissorientation and loss
of memeory)
 Renal failure
 Polyneuritis
 Delirium,coma,death
 MANAGEMENT

 Woman with hyperemesis gravidarum is admitted to hospital.

 Initially
nothing is given through mouth(at least 24 hrs after the
cessation of vomiting)
 Hypovolemia and electrolyte imbalance are corrected by
administering intravenous fluid.approximately 3L of fluid is to be
infused in 24hrs,out of which half is 5% dextrose half is ringer
solution. Extra amount of crstalloids equal to the amount of
vomitus and urine in 24hrs.
 Cont….management

 Enter through nasogastric tube is also helpful to manage the condition.

 Some woman are prescribed a mild sedative, if they are agitated.
 Supportive psychotherapy and counselling may help.
 Before the intravenous fluid is omitted, the food are given orally. At
first dry carbohydrate foods,like biscuits bread and toast are given.
Gradually ,full diet is restored.
 Cont…management

 Instruct the mother for dietary recommendations ,e.g.,

avoid taking fatty, spicy and preserved food items.
 Antiemetic (Phenergan 25mg,stemtil 5 mg twice daily)
 Hydrocortisone 100mg iv in the drip is given in case with
hypotension or in intractable vomiting. Oral prednisolone is
also used in severe cases.
Thank you