It is a severe type of vomiting of pregnancy which has got deleterious effect on the health
of the mother and/or incapacitates her in day to day activities.
Incidence - Less than 1 in 1000 pregnancy.
Etiology -
The etiology is obscure but the following are the known facts :
- It is mostly limited to the first trimester.
- It is more common in first pregnancy.
- It has got a familial history -mother and sister also suffer from the same manifestation.
- It is more prevalent in multiple pregnancy.
- It is more common in unplanned pregnancies.
Causes -
The exact causes are not known. There are some theories for hyperemesis gravidarum.
1. Hormonal - Progesterone excess leading to relaxation of the cardiac sphincter and
simultaneous retention of gastric fluids due to impaired gastric motility.
2. Psychogenic - It probably aggravates the 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. Dietary deficiency - Probably due to low carbohydrate reserve, as it happens after a night
without food.
4. Allergic or immunological basis.
5. Decrease gastric motility is found to cause nausea.
Sign and symptoms -
- Dry coated tongue.
- Sunken eyes.
- Acetone smell in breath.
- Tachycardia.
- Hypotension.
- Rise in temperature.
- Oliguria.
- Epigestric pain.
- Constipation.
Management -
Principles -
- To control vomiting.
- To correct the fluids and electrolytes.
- To prevent or to detect complications at earliest stage.
Hospitalization -
Whenever a patient is stamped as a case of hyperemesis gravidarum, she is admitted in hospital.
Fluids -
Oral feeding is withheld for at least 24 hours after the cessation of vomiting. During this period,
fluid is given through intravenous drip method. The amount of fluid to be infused in 24 hours is
approximate 3 litres, of which half is 5% dextrose and half is Ringer's solution.
Drugs -
a) Antiemetics drugs
- Promethazine (Phenargan) 25 mg
- Prochlorperazine (Stemetil) 5 mg
- Triflupromazine (Siquil) 10 mg
may be administered twice or thrice daily IM.
b) Nutritional support with vitamin B1, B6, B12 and vitamin C are given.
Diet -
- At first, dry carbohydrate foods like biscuit, bread and toast are given.
- Small but frequent feeds are recommended.
Complications -
- Neurological complications such as peripheral neuritis.
- Stress ulcer in stomach.
- Esophageal tear or rupture.
- Jaundice.
- Deep vein thrombosis.
of the mother and/or incapacitates her in day to day activities.
Incidence - Less than 1 in 1000 pregnancy.
Etiology -
The etiology is obscure but the following are the known facts :
- It is mostly limited to the first trimester.
- It is more common in first pregnancy.
- It has got a familial history -mother and sister also suffer from the same manifestation.
- It is more prevalent in multiple pregnancy.
- It is more common in unplanned pregnancies.
Causes -
The exact causes are not known. There are some theories for hyperemesis gravidarum.
1. Hormonal - Progesterone excess leading to relaxation of the cardiac sphincter and
simultaneous retention of gastric fluids due to impaired gastric motility.
2. Psychogenic - It probably aggravates the 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. Dietary deficiency - Probably due to low carbohydrate reserve, as it happens after a night
without food.
4. Allergic or immunological basis.
5. Decrease gastric motility is found to cause nausea.
Sign and symptoms -
- Dry coated tongue.
- Sunken eyes.
- Acetone smell in breath.
- Tachycardia.
- Hypotension.
- Rise in temperature.
- Oliguria.
- Epigestric pain.
- Constipation.
Management -
Principles -
- To control vomiting.
- To correct the fluids and electrolytes.
- To prevent or to detect complications at earliest stage.
Hospitalization -
Whenever a patient is stamped as a case of hyperemesis gravidarum, she is admitted in hospital.
Fluids -
Oral feeding is withheld for at least 24 hours after the cessation of vomiting. During this period,
fluid is given through intravenous drip method. The amount of fluid to be infused in 24 hours is
approximate 3 litres, of which half is 5% dextrose and half is Ringer's solution.
Drugs -
a) Antiemetics drugs
- Promethazine (Phenargan) 25 mg
- Prochlorperazine (Stemetil) 5 mg
- Triflupromazine (Siquil) 10 mg
may be administered twice or thrice daily IM.
b) Nutritional support with vitamin B1, B6, B12 and vitamin C are given.
Diet -
- At first, dry carbohydrate foods like biscuit, bread and toast are given.
- Small but frequent feeds are recommended.
Complications -
- Neurological complications such as peripheral neuritis.
- Stress ulcer in stomach.
- Esophageal tear or rupture.
- Jaundice.
- Deep vein thrombosis.
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