Hyper emesis gravidarum

Out lines ..

1) Definition

2) Etiology

3)Risk factors

4) Differentiate between morning sickness & hyperemesis

5) Sings and symptoms

6) Maternal & Fetal effect of hyperemesis gravid rum

7) Therapeutic management

8) Nursing management

Definition ..

Emesis gravid arum “ morning sickness”

A Sensation of nausea or vomiting especially in the morning. It appears at the 6th week & disappears after the 12th week of pregnancy.

Hyper emesis gravidarum “pernicious vomiting of vomiting”

A specific condition that occurs in early pregnancy characterized by :

-Excessive continues vomiting that affect the general condition

Dehydration and loss of body weight

emesis gravidarum affect 50% to 80% of pregnant women , hyperemesis gravid arum occurs in only approximately 1% to 2% of

Etiology..

There is no specific cause of hyperemesis but there is some theory..

i. Allergic manifestation to HCG which are secreted in increasing amount in early pregnancy. This most accepted theory. Hyperemesisare more frequent in cases of vesicular mole as HCG is secreted in large amount.

ii. Neurosis probably acts as aggravating factor and may be responsible that a mild vomiting become hyperemesis gravidarum.

iii. Adrenocortical insufficiency as this predisposes to allergic phenomena

Risk Factors ..

oMultiple pregnancies.

oWomen experiencing their first pregnancy.

o Underweight and obesity.

o Young woman.

o Psycho-social factors such as unwanted.

o Pregnancy , marital problem……etc..

oHaving a history of HG.

o Being pregnant with more than one baby.

o Being a first-time mother.

Morning sickness Hyper emesis

Common

Usually confined to the morning

Dose not affects the general condition.

Improved about the 12th week of pregnancy with treatment (e.g. vitamin B6) or without any treatment.

Rare

Repeated throughout the day

Affect the general condition

Has aggressive course and it fetal unless efficient treatment is rapidly given.(almost in the hospital.

Differentiate between morning sickness & hyperemesisgravidarum..

Signs & symptom..

Symptoms :• The condition usually starts as emesis then is proceed to

hyperemesis

• Continuous vomiting day & night • Thirst and constipation

• In severe cases the vomitus is bile or blood stained

Signs :• Loss of 5% or more of pre-pregnancy body weight (pocket weight)

• Dehydration results in :

Sunken eye and dry tongue

The pulse is weak and rapid

The blood pressure is low

The temperature is slightly raised

Decreased vitamin k causes coagulation disorders

Elevated liver enzyme, jaundice

The effect of HEG on the mother..

cont..

• Weight loss

• Dehydration

• Electrolyte imbalance “hypokalemia, hypernatremia ,acidosis from starvation, alkalosis from loss of hydrochloric acid in gastric fluid

• Short term hepatic dysfunction

• Risk for preterm labor

• Maternal death

• Depression is common secondary complication of HEG

The effect of HEG on the Fetus

Cont..

Intrauterine growth restriction IUGRFetal anomalies If it uncontrolled fetal death may occur IUFDLow birth weight

Therapeutic management

• Laboratory studies for HB , HCT, Na , K , Chloride & creatinine.• vitamins such as pyridoxine(B6) and thiamine (B1) have consistant evidence of benefit • Antiemetic promethazine (Phenergan) gives short term relief.• treatment of HG may include antiemetic medication and IV rehydration .If medication and

IV rehydration are insufficient , nutritional support may be required.• The standard of treatment in most of the worled is benedictin (diclectin) , a combination of

doxylamine succinte(sedating antihistaminic) , and vitamin B6 pyridoxine.

• the drug that act on central nervous system ondansetron (Zofran) or metoclopramide

(raglan) may be used.

• management of HG can be complicated because not all women respond to treatment

Nursing management ..

Assessment

1) Assess for signs of dehydration

2) Assess intake & output.

3) Assess the psychological status of the mother

4) Assess past & current weight .

5)Assess liver enzymes , CBC, HCT , BUN ,……

6)Assess vital signs

7) Assess the presence of ketones in the urine

Nursing intervention

Nursing intervention• provide mouth and skin care.• Keep clean and quiet environment• Eat small amount of meals every 2-3hrs• Low fats and easily digested carbohydrate• Sleep in a well ventilated room • provide psychological support.• Give parenteral fluids: electrolytes, glucose and vitamins according to program• Provide nutrition in small but frequent portions• Monitor the provision of fluids and food in 24 hours as well as expenditures and recorded

fluid intake.• Review of edema in the legs or elsewhere.• Do collaborations with other teams for the administration of antiemetic drugs.

Nursing intervention cont.

• Give the food a light, when it is allowed in small portions and frequent (liquid and solid)

• Increase feeding of this, if the client is able to accept (tolerance).

• Monitor FHR and fetal activity.• Monitor symptoms of morning sickness..• Examine the skin: the texture and turgor.• Encourage clients to multiply the rest.• Create a comfortable environment.

Planning ..

The nursing interventions focus on:Reducing nausea and vomiting.Maintaining nutrition and fluid balance Providing emotional support.Evaluation:The nurse evaluate the plan for care on the basis of

diagnosis and outcome goals.

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