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HYPEREMESIS GRAVIDARUM

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

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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

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RISK FACTORS Hyperthyroidism

GI abnormality

Pregestational diabetes

Psychiatric illness

Asthma

Female fetus or multiple fetuses

Multiple gestation

Previous HG

Nulliparity

Trophoblastic diseases

Obesity

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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.

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ASSOCIATED THEORIES FOR PATHOPHYSIOLOGY Hormonal

Gastrointestinal dysfunction

Infection

Vestibular and olfaction

Metabolic derangement

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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.

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GASTROINTESTINAL DYSFUNCTION

Thyroid disorder Elevated estrogen or progesterone vasopressin

Abnormal myoelectric activity

Gastric dysrhythmias

Nausea

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

Morning sickness is might be due to vestibular disorder.

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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

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PUQE CLASSIFICATION

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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

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COMPLICATION IN FETUS LBW

Small for gestational

Preterm

Intracranial hemorrhage

If mother gain atleast 7 kg than there is less complication

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MANAGEMENT Diet modification

More fluids

Vitamins

Ginger extract

Antiemetics and IVFs

Pyridoxine/doxylamine + vit B6

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

Charlotte Bronte died at her 4th month of pregnancy

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THANK YOU