Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 16 views

    Hyperemesis Gravidarum

    Uploaded by

    احمد احمد
    A 26-year-old pregnant woman presents to the emergency department complaining of nausea and vomiting 3 times per day for the past 3 days. She has amenorrhea for 2 months. This case involves hyperemesis gravidarum, an excessive vomiting condition during pregnancy that can cause dehydration, electrolyte imbalances, and weight loss. Risk factors include younger age, first pregnancy, and multiple pregnancy. Treatment involves IV fluids, electrolyte replacement, antiemetics like promethazine, and thiamine supplementation. Termination of pregnancy may be considered if vomiting persists despite treatment or complications develop like renal issues or jaundice.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Hyperemesis Gravidarum

    Uploaded by

    احمد احمد
    16 views13 pages
    A 26-year-old pregnant woman presents to the emergency department complaining of nausea and vomiting 3 times per day for the past 3 days. She has amenorrhea for 2 months. This case involves hyperemesis gravidarum, an excessive vomiting condition during pregnancy that can cause dehydration, electrolyte imbalances, and weight loss. Risk factors include younger age, first pregnancy, and multiple pregnancy. Treatment involves IV fluids, electrolyte replacement, antiemetics like promethazine, and thiamine supplementation. Termination of pregnancy may be considered if vomiting persists despite treatment or complications develop like renal issues or jaundice.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    A 26-year-old pregnant woman presents to the emergency department complaining of nausea and vomiting 3 times per day for the past 3 days. She has amenorrhea for 2 months. This case involves hyperemesis gravidarum, an excessive vomiting condition during pregnancy that can cause dehydration, electrolyte imbalances, and weight loss. Risk factors include younger age, first pregnancy, and multiple pregnancy. Treatment involves IV fluids, electrolyte replacement, antiemetics like promethazine, and thiamine supplementation. Termination of pregnancy may be considered if vomiting persists despite treatment or complications develop like renal issues or jaundice.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    16 views13 pages

    Hyperemesis Gravidarum

    Uploaded by

    احمد احمد
    A 26-year-old pregnant woman presents to the emergency department complaining of nausea and vomiting 3 times per day for the past 3 days. She has amenorrhea for 2 months. This case involves hyperemesis gravidarum, an excessive vomiting condition during pregnancy that can cause dehydration, electrolyte imbalances, and weight loss. Risk factors include younger age, first pregnancy, and multiple pregnancy. Treatment involves IV fluids, electrolyte replacement, antiemetics like promethazine, and thiamine supplementation. Termination of pregnancy may be considered if vomiting persists despite treatment or complications develop like renal issues or jaundice.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 13

    Hyperemesis gravidarum

    Case
    A 26-yrs- old primigravida presents to emergency
    with history of amenorrhea 2 months, she
    complaining of nausea & vomiting 3 episodes /day
    for past 3 days?
    Definition
    Prolong excessive vomiting and nausea ,leading to dehydration, ketosis electrolyte
    disturbance, and in sever cases weight loss.

    Incidence
    Affects 1:1000 pregnancy.

    Risk factors
     Younger maternal age
     Non-smoker
     first pregnancy
     Multiple pregnancy
     Gestational trophoblastic disease
     Previous history of hyperemesis gravdarum
     H pylori infection
    Causes

    There are numerous theories regarding the cause of HG, but the cause remains
    controversial. It is thought that HG is due to a combination of factors which may
    vary between women and include: genetics,body chemistry, and overall health.
    One factor is an adverse reaction to the hormonal changes of pregnancy, in
    particular, elevated levels of beta human chorionic gonadotropin. This theory
    would also explain why hyperemesis gravid arum is most frequently encountered
    in the first trimester (often around 8–12 weeks of gestation), as hCG levels are
    highest at that time and decline afterward. Another postulated cause of HG is an
    increase in maternal levels of progesterone (decreasing intestinal motility and
    gastric emptying leading to nausea/vomiting
    ). Allergy to corpus luteum and improve by antihistamine. Neurotic theory, mild hy
    perthyroidism and deficiency of carbohydrate.
    pathophysiology
     Eye show fundal with optic neuritis. Retinal hemorrhage or detachment.
     Brain show congestion and petechial hemorrhage.
     Heart small, atrophy and may be subendocardial hemorrhage.
     Liver small with fatty infiltration.
     Kidneys show degeneration of tubules.
     Peripheral nerves may show degeneration and polyneuritis.
    Diagnosis
     Symptoms and signs
     First trimester of pregnancy
     Vomiting
     Weight loss
     Muscle wasting
     Dehydration(dry tongue,emaciated,rapid puls,hypotention and oliguria
     jaundice
     Ptylism(inability to swallow saliva)
     Hypovolaemia
     Electrolyte imbalance
     Haematemesis(mallory-weiss tears)
     Behavior disorder
    investigation
     Urinalysis to detect ketones,proteinuria,bile salt and↓specific gravity.
     Msu to detect UTI.
     FBC (↑hematocrit indicate severity of dehydration).
     U and E(↓K,↓ Na,metabolic hypochloraemic alkalosis and ↑urea).
     LFT(↑transaminases,↓albumin).
     US to exclude multiple and molar pregnancy and confirm viable intrauterine
    pregnancy.
     Transient biochemical thyrotoxicosis due to thyrotropic action of HCG.
    Complication
    maternal risks
     Recurrent hospital attendances or admissions,this can lead to depression in 60% of
    women,with some electing to terminate the pregnancy.
     Lose of weight, dehydration and ketoacidosis.
     Liver and renal failure.
     Hyponatremia and rapid correction of it leading to central pontine myelinosis.
     Thiamine deficiency (B1) may lead to Wernicke‫؛‬s encephalopathy.
     Peripheral neuropathy.
     Esophageal rupture(Mallory-Weiss tears).
     Coagulopathy.

    Feta risks
     IUGR .
     Fetal death may occurs in case with Wernicke‫؛‬s encephalopathy.
    Differential diagnosis
    Diagnoses to be ruled out include the following

     Disease of pregnancy: ectopic pregnancy, mole pregnancy,preclampsia and


    acute polyhydramnios.
     Gynecological lesions: red degeneration of fibroid or twisted ovarian cyst.
     Medical conditioned or food poisoning.
     Surgical conditions as appendicitis.
    Treatment
     Exclude other causes of vomiting.
     Admission if sever dehydration and not tolerate oral fluid.
     IV fluid(Nacl or Hartman solution and avoid dextrose-containing fluids as thy
    precipitate Wernicke's encephalopathy.
     Daily U and E –replace electrolyte if need.
     Keep NBM for 24 hrs.' ,then introduce light diet as tolerated.
     Antiemetic-first line are promethazine and cyclizine,second line are
    metoclopramide ,third line include domperidone and in intractable case, a short
    course of steroid can be used(5mg TDS for 5 days or hydrocortisone 100mg/12h iv).
     Thiamine supplementation should give to all women in this situation(25-50mg PO
    TDS or thiamine 100mg iv infusion weekly.
     Consider thromboprophylaxis.
     The absence of urinary ketones is useful in management as it indicate that is no
    longer in catabolic metabolism and that the ketosis from dehydration is resolving.
     Termination of pregnancy indicated if:
    1. Persist vomiting in spit of treatment.
    2. Urinary change in form of oliguria and proteinuria.
    3. High serum creatinine.
    4. Jaundice.
    5. Presence of fundal changes.
    6. Occurrence of Wernicke encephalopathy.
     Methods of termination:
     If pregnancy is less than 12 weeks we do vaginal or suction evacuation.
     Oxytocin infusion if fail hysterotomy,and avoid halothane in anesthesia as
    hepatotoxic effect.
    Thank
    you

    You might also like