Hyperemesis Gravidarum

Subject: Midwifery I (Theory)

Overview

Hyperemesis gravidarum is acute vomiting in pregnancy, especially during the first trimester, that has a negative impact on the mother's health and/or her ability to carry out daily tasks. Starvation causes weight loss, dehydration, and acidosis. Vomiting affects 50 percent of pregnant women. However, in certain situations, morning sickness lasts all day and inhibits the mother's desire to eat, resulting in dehydration and ketosis.

Hyperemesis gravidarum is a wave of severe, continuous nausea and vomiting that causes dehydration, weight loss, and electrolyte abnormalities during pregnancy.

Causes

  1. Excessive chorionic gonadotropin
  2. Hyperoestrinism
  3. Adrenocortical insufficiency
  4. Unwanted pregnancy
  5. Diet deficiency

Risk Factors

  1. First-time pregnancy
  2. Multiple pregnancies
  3. Obesity
  4. History of hyperemesis gravidarum

Signs and Symptoms

  1. Weakness due to excessive vomiting
  2. Weight loss that is gradual
  3. Rapid pulse- 100 to 200 or more beats per minute
  4. Low blood pressure
  5. Dry tongue
  6. Jaundice
  7. Noxious breath
  8. Teeth ailment
  9. Lips and mouth discomfort
  10. Constipation
  11. Epigastric discomfort
  12. Persistent proteinuria

Test and Investigation

  1. History taking
  2. Physical examination
  3. Urine analysis
  4. Complete blood count
  5. Urine ketones
  6. Blood Urea nitrogen
  7. Liver function test
  8. Thyroid function test
  9. Hematocrit

Treatment

  1. Adequate sleep and rest.
  2. Increased fluid consumption
  3. Consume modest, light meals on a regular basis.
  4. Avoid triggers such as toothpaste, sound, and noise.
  5. Consider dry meals such as biscuits and crackers.
  6. Begin IV infusion to restore electrolyte and hydration balances.
  7. Take medicine as prescribed.

Management

  1. The patient was hospitalized due to extreme nausea and vomiting.
  2. Assure the mother that she will be better over time.
  3. Provide total bed rest, as well as monitor and record overall vitals.
  4. Check for signs of dehydration and begin IV fluid replacement.
  5. Orally or parentally administer vitamin B12, C, Folic acid, and iron.
  6. Encourage sorely needed tests such as CBC, hemoglobin, urea, sugar, electrolytes, urine R/E, and C/S.
  7. Maintain the patient in a well-ventilated environment.
  8. As directed by the doctor, administer an appropriate sedative to guarantee sleep.
  9. Anti-emetic medications are used to minimize vomiting.
  10. Maintain the patient's intake and output.
  11. Give the patient daily nursing care such as oral care, nail care, and bathing.
  12. Encourage the consumption of soft and light foods that are readily digestible.

References

  • HealthLine. 2005. 2017 http://www.healthline.com/health/hyperemesis-gravidarum
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/001499.htm
  • Sweet, B.r., 1989, Maye's midwifery, A textbook for midwives; 11th edition, Bailliere Tindall, London, Philadelphia
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
  • Tuitui R. 2002, A textbook of Midwifery B (Intranasal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/254751-overview
  • Web MD. 2005. 2017 http://www.webmd.com/baby/guide/what-is-hyperemesis-gravidarum#1
Things to remember
  • The precise causes are unknown.
  • Begin IV infusion to restore hydration and electrolyte balances by eating small, light meals on a regular basis.
  • Orally or parentally administer vitamin B12, C, Folic acid, and iron.
  • Anti-emetic medications are used to minimize vomiting.
Videos for Hyperemesis Gravidarum
hyperemesis gravidarum
Questions and Answers

Hyperemesis gravidarum is a severe, persistent nausea and vomiting that causes dehydration, weight loss, 

  1. Hyperemesis Gravidarum

Hyperemesis gravidarum is an extreme, persistent nausea vomiting during pregnancy which leads to dehydration, weight loss, and electrolyte imbalances.

Causes

  1. The exact causes are unknown
  2. Other possible causes are:
  3. Excessive chorionic gonadotropin
  4. Hyperoestrinism
  5. Adreno- cortical insufficiency
  6. Unwanted pregnancy
  7. Diet deficiency

 

Risk factors

  1. First-time pregnancy
  2. Multiple pregnancies
  3. Obesity
  4. History of hyperemesis gravidarum

 

Signs and symptoms

  1. Excessive vomiting
  2. Weakness
  3. Progressive weight loss
  4. Rapid pulse- 100 to 200 or more/min
  5. Low blood pressure
  6. Dry tongue
  7. Jaundice
  8. Offensive breathe
  9. Sore on teeth
  10. Sore lips and around mouth
  11. Constipation
  12. Epigastric pain
  13. Persistent proteinuria

Test and investigation

  1. History taking
  2. Physical examination
  3. Urine analysis
  4. Complete blood count
  5. Urine ketones
  6. Blood Urea nitrogen
  7. Liver function test
  8. Thyroid function test
  9. Hematocrit

Treatment

  1. Adequate rest and sleep.
  2. Increased fluid intake
  3. Eat small, light and frequent meal
  4. Avoid triggers like toothpaste, sound, noise
  5. Take dry foods like biscuits, crackers.
  6. Start IV infusion to restore the hydration and electrolyte balances.
  7. Take medication as a prescription.

Management

  1. Hospitalized the patient in severe nausea vomiting
  2. Reassure the mother that she will be improved by the time.
  3. Provide the complete bed rest and monitor overall vitals and record.
  4. Check for the signs of dehydration and start IV to replace the fluid loss.
  5. Provide vitamin B12, C, Folic acid, iron orally or parentally.
  6. Encourage for so necessary investigation like CBC, hemoglobin, urea, sugar, electrolyte, urine R/E and C/S
  7. Keep the patient in the well-ventilated room.
  8. Provide adequate sedation as doctor order to ensure sleep.
  9. Anti-emetics drugs to reduce vomit.
  10. Maintain intake and output of the patient.
  11. Provide daily nursing care to the patient like oral care, nail care, and bath.
  12. Encourage to take soft and light foods which can be easily digestible.

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