HYPEREMESIS GRAVIDARUM

HYPEREMESIS GRAVIDARUM

Hyperemesis gravidarum is excessive nausea and vomiting during pregnancy. This pernicious vomiting is differentiated from the more common and more normal morning sickness by the fact that it is of greater intensity and extends beyond the first trimester. Hyperemesis gravidarum may occur in any of the three trimesters. It is a condition affecting one in 1,000 pregnancies.

Causes

High levels of hCG or undue sensitivity to normal levels of hCG may cause vomiting. Psychological factors are thought to play an important role. Women with a previous history of hyperemesis are likely to experience it in subsequent pregnancies (Fairweather, 1968). It is known to be associated with first pregnancies. An allergic factor may also be operative, since large amounts of histamine are found in cases of hyperemesis. The sensitizing agents possibly are the woman's own corpus luteum, syncytial cells and gonadotropic hormones.

Clinical Presentation

Pernicious vomiting (anything taken orally is rejected) Poor appetite and poor nutritional intake Loss of more than 25% of body weight

Dehydration and electrolyte imbalance Acidosis due to starvation

. Alkalosis resulting from loss of hydrochloric acid in the vomitus

Occasionally, jaundice develops in severe cases . Low urine output

Rapid pulse and low blood pressure Hemoconcentration with rising blood urea nitrogen and falling sodium, potassium and chloride.

The condition is said to be mild when there is loss of weight, but no dehydration. Moderate cases are those characterized by dehydration and circulatory changes. Severe cases have biochemical changes with complications.

Complications

. Circulatory failure . Jaundice due to liver involvement .Retinal hemorrhage

⚫ Wernicke's encephalopathy and Korsakoff's syndrome (disorientation and loss of memory) Renal insufficiency

• Polyneuritis • Delirium, coma, death.

Treatment

Women with hyperemesis gravidarum are admitted to the hospital. Initially nothing is given by mouth. Hypovolemia and electrolyte imbalance are corrected by intravenous infusion. Vitamin supplements are given parenterally. Fluids and diet are gradually introduced as the woman's condition improves.

The mother should be encouraged to rest and be cared for in a single room. Some women are prescribed a mild sedative if they are agitated. Supportive psychotherapy and counseling may help. Small palatable meals, at regular intervals may help

the mother to regain her appetite. Antihistamines may be prescribed for treatment of nausea and vomiting. Patient's weight is taken twice a week to monitor the recovery.

Termination of pregnancy is recommended in evious severe cases with jaundice, persistent albuminuria, and polyneuritis to reverse the condition and to prevent

 Nursing Process for Clients with Hyperemesis

Assessment

. Intractable vomiting

. Weight loss of 25% or more . Ketosis, ketonuria (alkalosis)

Dehydration-poor skin turgor, dry tongue ⚫Epigastric pain el que urnid

• Drowsiness and confusion

Uncoordinated movements, jerking

⚫ Jaundice.