Hyperemesis gravidum

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 1

HYPEREMESIS GRAVIDARUM

Hari Prakash BharathiGroup 4 Year 6Faculty of MedicineTbilisi State Medical University

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 2

WHAT IS HG? Severe vomiting continuing after 16 gw and not resolved by diet or antiemetic.

Characterized by weight loss, ketosis, alkalosis, dehydration and hypokalemia

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 3

RISK FACTORS Hyperthyroidism

GI abnormality

Pregestational diabetes

Psychiatric illness

Asthma

Female fetus or multiple fetuses

Multiple gestation

Previous HG

Nulliparity

Trophoblastic diseases

Obesity

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 4

EPIDEMIOLOGY More prominent in urban than rural areas

About 10% of pregnant women

Less in American Indians, Africans, some Asians

Risk decrease in increase in maternal age.

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 5

ASSOCIATED THEORIES FOR PATHOPHYSIOLOGY Hormonal

Gastrointestinal dysfunction

Infection

Vestibular and olfaction

Metabolic derangement

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 6

HORMONAL THEORY High hCG high TSH elevated T4 nausea

Critics: nausea and vomiting not a symptom of hyperthyroidism Severity of symptoms Signs of biochemistry is not universal in all HG.

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 7

GASTROINTESTINAL DYSFUNCTION

Thyroid disorder Elevated estrogen or progesterone vasopressin

Abnormal myoelectric activity

Gastric dysrhythmias

Nausea

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 8

VESTIBULAR AND OLFACTION Smell of meat, cooking foods, certain food items triggers nausea

Morning sickness is might be due to vestibular disorder.

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 9

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 10

CLINICAL PRESENTATION Sleeping disturbance

Hyper olfaction

Dysgeusia

Ptyalism

Mood changes

Decreased gustatory movements

Weight loss by 10%

Dehydration, ketosis

Ketoacidosis or thyrotoxicosis

Physical and emotional stress on pregnancy

Difficulty in daily activities

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 11

PUQE CLASSIFICATION

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 12

COMPLICATION IN WOMEN Anemia

Hyponatremia

Mallory Weiss tears

Hypoglycemia

Malnutrition

Acute renal failure

DVT, pulmonary embolism

Esophageal perforation or rupture

Wernicke encephalopathy

Hepatic disease

Seizures, coma or death

Pneumothorax or pneumomediastinum

Vitamin deficiency

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 13

COMPLICATION IN FETUS LBW

Small for gestational

Preterm

Intracranial hemorrhage

If mother gain atleast 7 kg than there is less complication

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 14

MANAGEMENT Diet modification

More fluids

Vitamins

Ginger extract

Antiemetics and IVFs

Pyridoxine/doxylamine + vit B6

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 15

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 16

NOTABLE CASES Catherine William, Duchess of Cambridge during her both pregnancy

Charlotte Bronte died at her 4th month of pregnancy

01/05/2023 TBILISI STATE MEDICAL UNIVERSITY 17

THANK YOU