SlideShare uma empresa Scribd logo
1 de 36
Hyperemesis Gravidarum
By
Dr. Ahmed Nasef
Assistant lecturer at
obstetrics& gynecology
department – Benha
university- Egypt
Hyperemesis gravidarum
Hyperemesis gravidarum
What is emesis
Emesis = vomiting
May be called morning sickness
It doesn’t affect general condition of the patient
Hyperemesis gravidarum
When it happens?
Occurs in 1st trimester of pregnancy
Usually happens in the morning so the name
morning sickness
Is it one of the normal symptoms of
pregnancy?
Yes emesis is one of the frequently occurring
symptoms of pregnancy
About more than two thirds of pregnant women
present with emesis
Hyperemesis gravidarum
What causes emesis with pregnancy?
The exact cause of morning sickness is
unknown. Hormonal changes are thought to
play a role in morning sickness especially rising
HCG levels in pregnancy 1st trimester
Hyperemesis gravidarum
Management
Reassurance that with the advance of pregnancy it will disappear
general advice
Avoid immediate recumbency after meals
Iron therapy should be temporarily stopped (nauseating) till after 1st trimester
Drinking plenty of water
Drinking water before and after meals
Take naps
Assurance of ventilation of home and workspace to eliminate nauseating
odors
Avoiding spicy foods
Eating small meals
Avoiding nauseating fatty food
Avoiding cigarette smoke
If no response there is need for medications
So where is the problem?
The problem is not in emesis, its in
hyperemesis
Hyperemesis gravidarum
But what is hyperemesis?
HEG
It is defined as severe recurrent vomiting to a
degree that affects the general condition
What is the incidence of HEG?
About 0.1 to 1% of pregnant women presented
by HEG
What are the causes of HEG?
Different theories explain HEG
Psychological theory
as it starts soon after knowing that she is pregnant
Only in front of her husband
Hormonal theory
Due to elevated levels of HCG (which occurs in
vesicular mole& in twins)
Increased levels of T3& T4 may play a role
Vitamin deficiency
B1& B6 deficiency
Who is at increased risk?
PG
Multiple gestations
Trophoblastic disease (as vesicular mole)
HEG in previous pregnancies
Overweight
Family history of HEG
Stages& clinical presentation of
HEG
1st stage of HEG
Vomiting of food, fluids Which starts mild then
increase in frequency to
become severe intolerable
may be all the day, not
related to meals, not
controlled by usual drugs
Then may be blood tinged
due to injury of esophagus&
pharynx from recurrent
attacks of vomiting (Mallory
Weiss syndrome)
2nd stage of HEG
Stage of starvation
Starvation
Dehydration
Electrolyte imbalance
(decreased Na, K, Cl)
Dry inelastic skin
Thirst sensation
Dry tongue
Drowsiness
Sunken eyes
Constipation
Oliguria
Hypotension
tachycardia
Hyperemesis gravidarum
3rd stage of HEG
Stage of organ affection Wernicke's encephalopathy
(degeneration of Wernicke's
area in basal ganglia in
brain)
Retinal detachment&
blindness
Starvation ketosis
Liver failure (fatty
infiltration& necrosis)
Kidney failure (tubular
necrosis)
Heart failure
What is ketosis?
Normally body uses glucose to meet energy
needs& major source for glucose is coming from
diet
But in case of HEG there is decrease in glucose
levels in diet so body use lipids to obtain energy
needs which will develop ketones which will be
elevated in blood and then passes out of the
body in urine
Management of HEG
Admission to hospital
Full history taking
Examination
Investigations
Observation
Treatment
Admission to hospital
Reassurance of the patient
Isolation in single room
Behave with sympathy with the patient
Speak with relatives especially husband to
decrease any psychological stress on the patient
Hyperemesis gravidarum
Investigations
CBC
Increased Hct (due to hypovolemia)
Electrolyte levels
Decreased Na& K levels in blood
Urine analysis
Increased ketones in urine& no glucose
Thyroid profile
T3& T4 may be increased
Liver function tests (ALT& AST)
Kidney function tests (serum creatinine)
Fundus examination
Diet
NPO
Iv fluids (till 24-48 hrs after stoppage of
vomiting)
Then restart gradually by clear fluids&
carbohydrate meals with no fats or spices
Drugs
1st line (histamine receptor blockers) which act on both CTZ&
VC in brain so decrease vomiting as meclizine& cyclizine
(Navidoxine)
2nd line (dopamine receptor blockers) which act on CTZ
AS metoclopramide (Primperan)& chlorpromazine (Neurazine)
3rd line (serotonin receptor blockers)
Which act on both CTZ& VC as ondanesteron& granisetron
(Zofran)
Vitamin B6 may be added
Corticosteroids may be added if no response to the above
drugs
observation
Mother
Frequency of vomiting
Vital data
Laboratory results
Fundus examination
Any symptoms suggestive of
organ affection
Fetus
Ultrasound (US)
When to do TOP?
Deterioration of the general condition in spite of
treatment
Deterioration of organs affected
Methods:
By use of ecbolics, D&C or suction evacuation in
1st trimester
Or may be hysterotomy if in 2nd trimester
Hyperemesis gravidarum
Take home messages
Emesis is normal association with pregnancy
but hyperemesis is abnormal
Hyperemesis is like starvation but is worse than
starvation because in HEG there is added
vomiting which worsen the condition
HEG may be a cause for TOP
HEG may cause blindness& organs failure
Hyperemesis gravidarum

Mais conteúdo relacionado

Mais procurados

Epilepsy in pregnancy
Epilepsy in pregnancy Epilepsy in pregnancy
Epilepsy in pregnancy DR MUKESH SAH
 
9. complication of postpartum
9. complication of postpartum9. complication of postpartum
9. complication of postpartumHishgeeubuns
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarumFahad Zakwan
 
3.physiolosical changes during pregnancy
3.physiolosical changes during pregnancy3.physiolosical changes during pregnancy
3.physiolosical changes during pregnancyKHUSHBU PATEL
 
CORD PROLAPSE AND CORD PRESENTATION.pptx
CORD PROLAPSE AND CORD PRESENTATION.pptxCORD PROLAPSE AND CORD PRESENTATION.pptx
CORD PROLAPSE AND CORD PRESENTATION.pptxKwizeravirgile1
 
Obstructed labor and uterine rupture
Obstructed labor and uterine ruptureObstructed labor and uterine rupture
Obstructed labor and uterine ruptureAkeFid
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancyOM VERMA
 
Routine & focused ANC
Routine & focused ANC Routine & focused ANC
Routine & focused ANC Nuru Mohammed
 
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.pptPOLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppttaneja_poonam
 
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its managementHyperemesis gravidarum and its management
Hyperemesis gravidarum and its managementsunil kumar daha
 
Pelvic inflammatory disease ppt
Pelvic inflammatory disease pptPelvic inflammatory disease ppt
Pelvic inflammatory disease pptMeenakshi Kaushik
 
Makalah deteksi patologi persalinan kala 1 “inersia uteri”
Makalah deteksi patologi persalinan kala 1 “inersia uteri”Makalah deteksi patologi persalinan kala 1 “inersia uteri”
Makalah deteksi patologi persalinan kala 1 “inersia uteri”Sentra Komputer dan Foto Copy
 
dysfunctional uterine bleeding
dysfunctional uterine bleedingdysfunctional uterine bleeding
dysfunctional uterine bleedingKarl Daniel, M.D.
 
Premature rupture of membranes
Premature rupture of membranesPremature rupture of membranes
Premature rupture of membranesDIVYA JAIN
 
Postpartum mood disorders
Postpartum mood disordersPostpartum mood disorders
Postpartum mood disordersraj kumar
 
First Stage of Labour and Midwifery Care
First Stage of Labour and Midwifery Care First Stage of Labour and Midwifery Care
First Stage of Labour and Midwifery Care Suha Baloushah
 
5. tanda tanda kehamilan--
5. tanda tanda kehamilan--5. tanda tanda kehamilan--
5. tanda tanda kehamilan--Devi Narti
 
Puerperal Pyrexia
Puerperal PyrexiaPuerperal Pyrexia
Puerperal PyrexiaFarjad Baig
 

Mais procurados (20)

Epilepsy in pregnancy
Epilepsy in pregnancy Epilepsy in pregnancy
Epilepsy in pregnancy
 
9. complication of postpartum
9. complication of postpartum9. complication of postpartum
9. complication of postpartum
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarum
 
3.physiolosical changes during pregnancy
3.physiolosical changes during pregnancy3.physiolosical changes during pregnancy
3.physiolosical changes during pregnancy
 
CORD PROLAPSE AND CORD PRESENTATION.pptx
CORD PROLAPSE AND CORD PRESENTATION.pptxCORD PROLAPSE AND CORD PRESENTATION.pptx
CORD PROLAPSE AND CORD PRESENTATION.pptx
 
Obstructed labor and uterine rupture
Obstructed labor and uterine ruptureObstructed labor and uterine rupture
Obstructed labor and uterine rupture
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
Routine & focused ANC
Routine & focused ANC Routine & focused ANC
Routine & focused ANC
 
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.pptPOLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
POLYHYDRAMNIOS AND OLIGOHYDRAMNIOS.ppt
 
Hyperemesis gravidarum and its management
Hyperemesis gravidarum and its managementHyperemesis gravidarum and its management
Hyperemesis gravidarum and its management
 
Vaginitis
VaginitisVaginitis
Vaginitis
 
Pelvic inflammatory disease ppt
Pelvic inflammatory disease pptPelvic inflammatory disease ppt
Pelvic inflammatory disease ppt
 
Makalah deteksi patologi persalinan kala 1 “inersia uteri”
Makalah deteksi patologi persalinan kala 1 “inersia uteri”Makalah deteksi patologi persalinan kala 1 “inersia uteri”
Makalah deteksi patologi persalinan kala 1 “inersia uteri”
 
dysfunctional uterine bleeding
dysfunctional uterine bleedingdysfunctional uterine bleeding
dysfunctional uterine bleeding
 
Premature rupture of membranes
Premature rupture of membranesPremature rupture of membranes
Premature rupture of membranes
 
Postpartum mood disorders
Postpartum mood disordersPostpartum mood disorders
Postpartum mood disorders
 
Menorrhagia
MenorrhagiaMenorrhagia
Menorrhagia
 
First Stage of Labour and Midwifery Care
First Stage of Labour and Midwifery Care First Stage of Labour and Midwifery Care
First Stage of Labour and Midwifery Care
 
5. tanda tanda kehamilan--
5. tanda tanda kehamilan--5. tanda tanda kehamilan--
5. tanda tanda kehamilan--
 
Puerperal Pyrexia
Puerperal PyrexiaPuerperal Pyrexia
Puerperal Pyrexia
 

Semelhante a Hyperemesis gravidarum

Vomiting in pregnancy
Vomiting in pregnancy Vomiting in pregnancy
Vomiting in pregnancy alyaqdhan
 
Vomiting in pregnancy for 4th year med. students
Vomiting in pregnancy for 4th year med. studentsVomiting in pregnancy for 4th year med. students
Vomiting in pregnancy for 4th year med. studentsDr. Aisha M Elbareg
 
Vomiting and GIT problems during pregnancy
Vomiting and GIT problems during pregnancyVomiting and GIT problems during pregnancy
Vomiting and GIT problems during pregnancyHassan Ahmed
 
Pre-Eclampsia and Hypertensive Disease in Pregnancy
Pre-Eclampsia and Hypertensive Disease in PregnancyPre-Eclampsia and Hypertensive Disease in Pregnancy
Pre-Eclampsia and Hypertensive Disease in Pregnancymeducationdotnet
 
hyperemesis gravidarum.pptx
hyperemesis gravidarum.pptxhyperemesis gravidarum.pptx
hyperemesis gravidarum.pptxSharwajitJha1
 
Hypertensive disorders in pregnancy
Hypertensive disorders in pregnancyHypertensive disorders in pregnancy
Hypertensive disorders in pregnancynandita Sr. Sarah
 
HYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUMHYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUMSumit Bidari
 
Hypertensive disorders in Pregnancy
Hypertensive disorders in PregnancyHypertensive disorders in Pregnancy
Hypertensive disorders in PregnancyHanifullah Khan
 
Interpretation of laboratory thyroid function tests
Interpretation of laboratory thyroid function tests Interpretation of laboratory thyroid function tests
Interpretation of laboratory thyroid function tests Hussam Elmouzi
 
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
 
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptx
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptxNausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptx
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptxMuhammad Fauzan Yunus
 
Approcah to vomiting
Approcah to vomitingApprocah to vomiting
Approcah to vomitingJason Dsouza
 
Case Presentation 07
Case Presentation 07Case Presentation 07
Case Presentation 07guesta7e312
 
Hypertensive disorder of pregnancy
Hypertensive disorder of pregnancyHypertensive disorder of pregnancy
Hypertensive disorder of pregnancyEngidaw Ambelu
 
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Võ Tá Sơn
 
Hypertension in pregnancy
Hypertension in pregnancyHypertension in pregnancy
Hypertension in pregnancyalyaqdhan
 
Hyperemesis Gravidarum And Preterm Labor
Hyperemesis Gravidarum And Preterm LaborHyperemesis Gravidarum And Preterm Labor
Hyperemesis Gravidarum And Preterm LaborReynel Dan
 

Semelhante a Hyperemesis gravidarum (20)

Vomiting in pregnancy
Vomiting in pregnancy Vomiting in pregnancy
Vomiting in pregnancy
 
Vomiting in pregnancy for 4th year med. students
Vomiting in pregnancy for 4th year med. studentsVomiting in pregnancy for 4th year med. students
Vomiting in pregnancy for 4th year med. students
 
Vomiting and GIT problems during pregnancy
Vomiting and GIT problems during pregnancyVomiting and GIT problems during pregnancy
Vomiting and GIT problems during pregnancy
 
Pre-Eclampsia and Hypertensive Disease in Pregnancy
Pre-Eclampsia and Hypertensive Disease in PregnancyPre-Eclampsia and Hypertensive Disease in Pregnancy
Pre-Eclampsia and Hypertensive Disease in Pregnancy
 
hyperemesis gravidarum.pptx
hyperemesis gravidarum.pptxhyperemesis gravidarum.pptx
hyperemesis gravidarum.pptx
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarum
 
Hypertensive disorders in pregnancy
Hypertensive disorders in pregnancyHypertensive disorders in pregnancy
Hypertensive disorders in pregnancy
 
HYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUMHYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUM
 
Hypertensive disorders in Pregnancy
Hypertensive disorders in PregnancyHypertensive disorders in Pregnancy
Hypertensive disorders in Pregnancy
 
Interpretation of laboratory thyroid function tests
Interpretation of laboratory thyroid function tests Interpretation of laboratory thyroid function tests
Interpretation of laboratory thyroid function tests
 
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
 
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptx
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptxNausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptx
Nausea and vomiting in pregnancy and Hyperemesis Gravidarum.pptx
 
Approcah to vomiting
Approcah to vomitingApprocah to vomiting
Approcah to vomiting
 
Vomiting-in-Pregnancy.pptx
Vomiting-in-Pregnancy.pptxVomiting-in-Pregnancy.pptx
Vomiting-in-Pregnancy.pptx
 
Case Presentation 07
Case Presentation 07Case Presentation 07
Case Presentation 07
 
Case Presentation 07
Case Presentation 07Case Presentation 07
Case Presentation 07
 
Hypertensive disorder of pregnancy
Hypertensive disorder of pregnancyHypertensive disorder of pregnancy
Hypertensive disorder of pregnancy
 
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018
 
Hypertension in pregnancy
Hypertension in pregnancyHypertension in pregnancy
Hypertension in pregnancy
 
Hyperemesis Gravidarum And Preterm Labor
Hyperemesis Gravidarum And Preterm LaborHyperemesis Gravidarum And Preterm Labor
Hyperemesis Gravidarum And Preterm Labor
 

Mais de Ahmed Nasef

Health facility practices to support breast feeding.pptx
Health facility practices to support breast feeding.pptxHealth facility practices to support breast feeding.pptx
Health facility practices to support breast feeding.pptxAhmed Nasef
 
Common breast feeding problems in postpartum period and their solutions.pptx
Common breast feeding problems in postpartum period and their solutions.pptxCommon breast feeding problems in postpartum period and their solutions.pptx
Common breast feeding problems in postpartum period and their solutions.pptxAhmed Nasef
 
lactation management in postpartum period.pptx
lactation management in postpartum period.pptxlactation management in postpartum period.pptx
lactation management in postpartum period.pptxAhmed Nasef
 
Breast feeding support in the postpartum period & benefits of BF.pptx
Breast feeding support in the postpartum period & benefits of BF.pptxBreast feeding support in the postpartum period & benefits of BF.pptx
Breast feeding support in the postpartum period & benefits of BF.pptxAhmed Nasef
 
Human Papilloma Virus(HPV).pptx
Human Papilloma Virus(HPV).pptxHuman Papilloma Virus(HPV).pptx
Human Papilloma Virus(HPV).pptxAhmed Nasef
 
ovarian neoplasm.pptx
ovarian neoplasm.pptxovarian neoplasm.pptx
ovarian neoplasm.pptxAhmed Nasef
 
CIN, pap smear, colposcopy.pptx
CIN, pap smear, colposcopy.pptxCIN, pap smear, colposcopy.pptx
CIN, pap smear, colposcopy.pptxAhmed Nasef
 
smoking& breast feeding.pptx
smoking& breast feeding.pptxsmoking& breast feeding.pptx
smoking& breast feeding.pptxAhmed Nasef
 
Breast feeding support in the perinatal period.pdf
Breast feeding support in the perinatal period.pdfBreast feeding support in the perinatal period.pdf
Breast feeding support in the perinatal period.pdfAhmed Nasef
 
DSD (Disorders of sexual development), Intersex.pptx
DSD (Disorders of sexual development), Intersex.pptxDSD (Disorders of sexual development), Intersex.pptx
DSD (Disorders of sexual development), Intersex.pptxAhmed Nasef
 
Acute abdomen with pregnancy
Acute abdomen with pregnancyAcute abdomen with pregnancy
Acute abdomen with pregnancyAhmed Nasef
 
Fertilization, placenta, umbilical cord& amniotic fluid
Fertilization, placenta, umbilical cord& amniotic fluidFertilization, placenta, umbilical cord& amniotic fluid
Fertilization, placenta, umbilical cord& amniotic fluidAhmed Nasef
 

Mais de Ahmed Nasef (14)

Health facility practices to support breast feeding.pptx
Health facility practices to support breast feeding.pptxHealth facility practices to support breast feeding.pptx
Health facility practices to support breast feeding.pptx
 
Common breast feeding problems in postpartum period and their solutions.pptx
Common breast feeding problems in postpartum period and their solutions.pptxCommon breast feeding problems in postpartum period and their solutions.pptx
Common breast feeding problems in postpartum period and their solutions.pptx
 
lactation management in postpartum period.pptx
lactation management in postpartum period.pptxlactation management in postpartum period.pptx
lactation management in postpartum period.pptx
 
Breast feeding support in the postpartum period & benefits of BF.pptx
Breast feeding support in the postpartum period & benefits of BF.pptxBreast feeding support in the postpartum period & benefits of BF.pptx
Breast feeding support in the postpartum period & benefits of BF.pptx
 
Cervicitis.pptx
Cervicitis.pptxCervicitis.pptx
Cervicitis.pptx
 
Human Papilloma Virus(HPV).pptx
Human Papilloma Virus(HPV).pptxHuman Papilloma Virus(HPV).pptx
Human Papilloma Virus(HPV).pptx
 
ovarian neoplasm.pptx
ovarian neoplasm.pptxovarian neoplasm.pptx
ovarian neoplasm.pptx
 
CIN, pap smear, colposcopy.pptx
CIN, pap smear, colposcopy.pptxCIN, pap smear, colposcopy.pptx
CIN, pap smear, colposcopy.pptx
 
smoking& breast feeding.pptx
smoking& breast feeding.pptxsmoking& breast feeding.pptx
smoking& breast feeding.pptx
 
Breast feeding support in the perinatal period.pdf
Breast feeding support in the perinatal period.pdfBreast feeding support in the perinatal period.pdf
Breast feeding support in the perinatal period.pdf
 
DSD (Disorders of sexual development), Intersex.pptx
DSD (Disorders of sexual development), Intersex.pptxDSD (Disorders of sexual development), Intersex.pptx
DSD (Disorders of sexual development), Intersex.pptx
 
Acute abdomen with pregnancy
Acute abdomen with pregnancyAcute abdomen with pregnancy
Acute abdomen with pregnancy
 
Vulvovaginitis
VulvovaginitisVulvovaginitis
Vulvovaginitis
 
Fertilization, placenta, umbilical cord& amniotic fluid
Fertilization, placenta, umbilical cord& amniotic fluidFertilization, placenta, umbilical cord& amniotic fluid
Fertilization, placenta, umbilical cord& amniotic fluid
 

Último

In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxAditiChauhan701637
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...raviapr7
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRATanmoy Mishra
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxMYDA ANGELICA SUAN
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfYu Kanazawa / Osaka University
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and stepobaje godwin sunday
 
How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17Celine George
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxDr. Santhosh Kumar. N
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptxraviapr7
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxKatherine Villaluna
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?TechSoup
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptxSandy Millin
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxSaurabhParmar42
 

Último (20)

In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptx
 
Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...Patient Counselling. Definition of patient counseling; steps involved in pati...
Patient Counselling. Definition of patient counseling; steps involved in pati...
 
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRADUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
Patterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptxPatterns of Written Texts Across Disciplines.pptx
Patterns of Written Texts Across Disciplines.pptx
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
General views of Histopathology and step
General views of Histopathology and stepGeneral views of Histopathology and step
General views of Histopathology and step
 
How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17
 
M-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptxM-2- General Reactions of amino acids.pptx
M-2- General Reactions of amino acids.pptx
 
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptxClinical Pharmacy  Introduction to Clinical Pharmacy, Concept of clinical pptx
Clinical Pharmacy Introduction to Clinical Pharmacy, Concept of clinical pptx
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
 
What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?What is the Future of QuickBooks DeskTop?
What is the Future of QuickBooks DeskTop?
 
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
2024.03.23 What do successful readers do - Sandy Millin for PARK.pptx
 
CAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptxCAULIFLOWER BREEDING 1 Parmar pptx
CAULIFLOWER BREEDING 1 Parmar pptx
 

Hyperemesis gravidarum

  • 1. Hyperemesis Gravidarum By Dr. Ahmed Nasef Assistant lecturer at obstetrics& gynecology department – Benha university- Egypt
  • 4. What is emesis Emesis = vomiting May be called morning sickness It doesn’t affect general condition of the patient
  • 6. When it happens? Occurs in 1st trimester of pregnancy Usually happens in the morning so the name morning sickness
  • 7. Is it one of the normal symptoms of pregnancy? Yes emesis is one of the frequently occurring symptoms of pregnancy About more than two thirds of pregnant women present with emesis
  • 9. What causes emesis with pregnancy? The exact cause of morning sickness is unknown. Hormonal changes are thought to play a role in morning sickness especially rising HCG levels in pregnancy 1st trimester
  • 11. Management Reassurance that with the advance of pregnancy it will disappear general advice Avoid immediate recumbency after meals Iron therapy should be temporarily stopped (nauseating) till after 1st trimester Drinking plenty of water Drinking water before and after meals Take naps Assurance of ventilation of home and workspace to eliminate nauseating odors Avoiding spicy foods Eating small meals Avoiding nauseating fatty food Avoiding cigarette smoke If no response there is need for medications
  • 12. So where is the problem?
  • 13. The problem is not in emesis, its in hyperemesis
  • 15. But what is hyperemesis?
  • 16. HEG It is defined as severe recurrent vomiting to a degree that affects the general condition
  • 17. What is the incidence of HEG? About 0.1 to 1% of pregnant women presented by HEG
  • 18. What are the causes of HEG? Different theories explain HEG Psychological theory as it starts soon after knowing that she is pregnant Only in front of her husband Hormonal theory Due to elevated levels of HCG (which occurs in vesicular mole& in twins) Increased levels of T3& T4 may play a role Vitamin deficiency B1& B6 deficiency
  • 19. Who is at increased risk? PG Multiple gestations Trophoblastic disease (as vesicular mole) HEG in previous pregnancies Overweight Family history of HEG
  • 21. 1st stage of HEG Vomiting of food, fluids Which starts mild then increase in frequency to become severe intolerable may be all the day, not related to meals, not controlled by usual drugs Then may be blood tinged due to injury of esophagus& pharynx from recurrent attacks of vomiting (Mallory Weiss syndrome)
  • 22. 2nd stage of HEG Stage of starvation Starvation Dehydration Electrolyte imbalance (decreased Na, K, Cl) Dry inelastic skin Thirst sensation Dry tongue Drowsiness Sunken eyes Constipation Oliguria Hypotension tachycardia
  • 24. 3rd stage of HEG Stage of organ affection Wernicke's encephalopathy (degeneration of Wernicke's area in basal ganglia in brain) Retinal detachment& blindness Starvation ketosis Liver failure (fatty infiltration& necrosis) Kidney failure (tubular necrosis) Heart failure
  • 25. What is ketosis? Normally body uses glucose to meet energy needs& major source for glucose is coming from diet But in case of HEG there is decrease in glucose levels in diet so body use lipids to obtain energy needs which will develop ketones which will be elevated in blood and then passes out of the body in urine
  • 26. Management of HEG Admission to hospital Full history taking Examination Investigations Observation Treatment
  • 27. Admission to hospital Reassurance of the patient Isolation in single room Behave with sympathy with the patient Speak with relatives especially husband to decrease any psychological stress on the patient
  • 29. Investigations CBC Increased Hct (due to hypovolemia) Electrolyte levels Decreased Na& K levels in blood Urine analysis Increased ketones in urine& no glucose Thyroid profile T3& T4 may be increased Liver function tests (ALT& AST) Kidney function tests (serum creatinine) Fundus examination
  • 30. Diet NPO Iv fluids (till 24-48 hrs after stoppage of vomiting) Then restart gradually by clear fluids& carbohydrate meals with no fats or spices
  • 31. Drugs 1st line (histamine receptor blockers) which act on both CTZ& VC in brain so decrease vomiting as meclizine& cyclizine (Navidoxine) 2nd line (dopamine receptor blockers) which act on CTZ AS metoclopramide (Primperan)& chlorpromazine (Neurazine) 3rd line (serotonin receptor blockers) Which act on both CTZ& VC as ondanesteron& granisetron (Zofran) Vitamin B6 may be added Corticosteroids may be added if no response to the above drugs
  • 32. observation Mother Frequency of vomiting Vital data Laboratory results Fundus examination Any symptoms suggestive of organ affection Fetus Ultrasound (US)
  • 33. When to do TOP? Deterioration of the general condition in spite of treatment Deterioration of organs affected Methods: By use of ecbolics, D&C or suction evacuation in 1st trimester Or may be hysterotomy if in 2nd trimester
  • 35. Take home messages Emesis is normal association with pregnancy but hyperemesis is abnormal Hyperemesis is like starvation but is worse than starvation because in HEG there is added vomiting which worsen the condition HEG may be a cause for TOP HEG may cause blindness& organs failure