HYPEREMESIS GRAVIDARUM

Pernicious or persistent vomiting

Introduction: A pregnant woman may experience some nausea and vomiting at early stage of pregnancy, this is one of the presumptive signs. Sometimes it is noticed even before the missed menstrual period. It is most apparent in the morning on rising that is why it is also interpreted as morning sickness. Nausea and vomiting begun to be noticed at the same time levels of HCG (Human Chorionic Gonadotropin Hormone) and progesterone begin to rise so this may contribute to its cause. In most pregnant women, mild to moderate nausea and vomiting are especially common until approximately 12 weeks or first trimester. Hyperemesis Gravidarum (somtimes called pernicious or persistent vomiting) is coined from the greek word hyper and emesis and latin word gravida meaning " excessive vomiting of the pregnant woman ". Hyperemesis Gravidarum is a severe form of morning sickness, it is primarily characterized by excessive nausea and vomiting of pregnancy that is prolonged for past week 12 of pregnancy. Hyperemesis gravidarum is defined variably as vomiting sufficiently severe to produce weight loss, dehydration, alkalosis from loss of hydrochloric acid, and hypokalemia. Acidosis develops from partial starvation (Williams obstetric). Distinguishing between morning sickness and hyperemesis gravidarum * Morning Sickness: * Nausea sometimes accompanied by vomiting * Hyperemesis Gravidarum: * Nausea accompanied by severe vomiting * Nausea that does not subside * Vomiting that causes severe dehydration * Vomiting that does not allow you to keep any food down

* Nausea that subsides at 12 weeks or soon after * Vomiting that does not cause severe dehydration

* Vomiting that allows you to keep some food down

It occurs at an incidence of 1 in 200-300 women. The cause is unknown, but women with disorder may have increased thyroid function because of the thyroidstimulating properties of HCG. Some studies revealed that it is associated with Helicobacter pylori, the same bacteria that causes peptic ulcers. Signs And Symtopms: When HG is severe and/or inadequately treated, it may result in: Excessive Nausea and Vomiting Poor Skin Turgor or Loss of Skin Elasticity Body Malaise Low Blood Pressure loss of 5% or more of pre-pregnancy body weight nutritional deficiencies difficulty with daily activities altered sense of taste sensitivity of the brain to motion food leaving the stomach more slowly rapidly changing hormone levels during pregnancy stomach contents moving back up from the stomach physical and emotional stress of pregnancy on the body Risk Factors: Pregnant Woman at her 2nd trimester Complications: Dehydration and Ketosis Metabolic Imbalances Esophageal rupture Hypoprothrombinemiavitamin K Hyperalimentation complications Mallory-Weiss syndrome ------bleeding,pneumothorax,pneumomediastinum,pneumopericardium Renal failuremay require dialysis Wernicke encephalopathythiamine deficiency

Fetal complications: Low birth weight (small for gestational age and premature babies) Miscarriage Mortality and Morbidity: Today, although Hyperemesis Gravidarum is still associated with significant morbidity. It is still a rare cause of maternal mortality.

Therapeutic Management: - Woman with Hyperemesis Gravidarum usually need to be hospitalized for about 24 hours to monitor intake, output and blood Chemistires and restore hydration - All oral food and fluids are usually withheld. - Intravenous fluid therapy (IV) to restore hydration, electrolytes - Tube feeding: Nasogastric restores nutrients through a tube passing through the nose and to the stomach - Administration of antiemetic drug such as metoclopramide, may be prescribed to control vomiting *ung differences between morning sickness,and HG itatable ko pa:)*