Vomiting In Pregnancy And Hyperemesis Gravidarum Explanation

Vomiting In Pregnancy Or Morning Sickness And Hyperemesis Gravidarum 

Hyperemesis Gravidarum
Hyperemesis Gravidarum

Vomiting in pregnancy morning sickness and Nausea and vomiting mostly common 50% to 88% of pregnancy during the first few months of pregnancy
This condition mainly start about 4 to 6 week after conception and peaks between 8 and 11 weeks and spontaneously subsides between 12 to 16 weeks of gestation (mostly at 12 weeks)

The main cause of this condition is the high level of human chorionic gonadotropin and low blood sugar level related to fasting while asleep and altered carbohydrate metabolism.

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Management

Advise

  • Advice to the patient is tension free mind and take rest, eat a small and frequent
  • meal every 2 hours the meal is high in carbohydrates and low in fat.
  • Avoid any smells or foods that trigger for symptoms
  • Use of Ginger products may be helpful to women
  • Use pharmacological agents including Vitamin B6 pyridoxine and antiemetic
  • drugs to relieve mild and moderate nausea and vomiting
  • Drink fluids like water juice between meal or food
  • Avoid spicy Gracy or fried foods and foods with strong odors
  • Eat dry crackers or toast before rising to bed

Hyperemesis gravidarum

Long time, continuous, severe nausea and vomiting related to pregnancy often accompanied by a dry etching. It has got a deleterious effect on the health of the mother and incapacitates her in day to day activates.
Incience – 1 in 1000 pregnancies

Etiology of Hyperemesis gravidarum

●Family history. Multiple pregnancies
●Increase the level of hCG hormone. Psychogenic
●Dietetic deficiency of B1 B6 protein & carbohydrate. Hydatidiform mole

Sign and symptoms of hyperemesis gravidarum
    • Symptoms mainly start between 4 and 7 weeks of gestation and resolve by 16 weeks in about 90% of women
    • Persistent vomiting throughout the day
    • Lack of Desire for food
    • hyper olfaction – increase sensitivity to smell
    • Ptyalism- excessive saliva secretion
    • Dehydration and depression of protein and electrolyte disturbance chloride Sodium and potassium
      ◆ clinical features are complications
    • Weight loss:- 10 to 20% of body weight
  • Hyponatremia:- leading to lethargy headache confusion nausea vomiting and seizures

Hypokalemia:- leading to skeletal muscles weakness and Cardiac arrhythmias

Vitamin Deficiencies
    • Vitamin B1 deficiency course Wernicke’s encephalopathy
    • Vitamin B12 and Vitamin B6 deficiency is may cause anemia and peripheral neuropathies
    • Mallory Weiss syndrome ( G K Mallory, US pathologist, and S Weiss, US internist)
  • Hemorrhage from the upper gastrointestinal tract due to a tear in the mucosa of the esophagus due to violent retching

Fetal complications

  • Low birth baby -Baby born with low birth weight lbw (small gestational age and premature babies)

Management of Hyperemesis gravidarum

Medical management
  • Antiemetic drug treatment:-
    This should only be given when symptoms are persistent severe and preventing daily activities

Drug treatment medicines are mainly:– Promethazine, chlorpromazine, metoclopramide, prochlorperazine, domperidone and ondansetron selective 5 hydroxytryptamine receptor agonist ) or combination of these agents
Proton pump inhibitor drugs like Omeprazole pantoprazole etcetera and histamine H2 receptor antagonist like ranitidine famotidine etc may be used in dysplasia and may be useful as an adjective treatment

Medical advice in hyperemesis gravidarum

    • Early management
    • Bed rest
    • Small frequent high carbohydrate feeding,
    • moderate fluid restrictions and mild sedation
    • Severe management
  • In this cases, the patient is hospitalized for complete bed rest and rehydration
    And 30 to 45 minutes after meal sitting upright to reduce gastric Reflux
    Termination of the pregnancy is indicated only when the women fail to respond to medical measures and are approaching serious physiological jeopardy