Facts to know about excessive vomiting in pregnancy (HYPEREMESIS GRAVIDARUM)

         HYPEREMESIS GRAVIDARUM

    Hyperemesis gravidarum is the  excessive nausea and vomiting that start between 4 and 10 weeks gestation, and resolve before 20 weeks requiring intervention
It affects 0.3-3% of all pregnant women, this is associated with dehydration,electrolyte imbalance and weight loss of up to 10% of prepregnant weight and should not be confused with the common symptoms of nausea and vomiting of pregnancy that are self-limiting.
   The aetiology of hyperemesis is uncertain, with multifactorial causes such as endocrine gastointestinal and HCG appear to be significance.

       FACTORS THAT CAN INCREASES HYPEREMESIS OCCURANCE

  • Hyperremesis occurs more often where mothers have a multiple pregnancy, or a hydatidiform mole, both of whicb are associated with increased hormone levels.
  • Infection with helicobacter pylori,the organism implicated in gastric ulcers,may also contribute
  • Women with a previous history of hyperemesis are likely to experience it in subsequent pregnancies.
  • Rising levels of oestrogen and HCG appear to be significant. 

   The impact of nausea and vomiting on the woman and her daily life should not be underestimated.Diagnosis is made where there is a history of persistent severe nausea and vomiting in early pregnancy
A history of the frequency and severity of the bouts of vomiting is taken.The mother's appearance is noted including any dryness or inelasticity of the skin.in severe jaundice may be apparent.This may indicate hepatic involvement,the cause of which is unclear.Addititonal signs of dehydration such as rapid pulse,low blood pressure and dry furred tongue may be seen.The mothers breath may smell of acetone,a sign of ketosis.ptyalism may occur contributing to dehydration,Elevated haematocrit,alterations in electrolyte levels and ketonuria are associated with dehydration.
Hypovolaemia and electrolyte imbalance are corrected by intravenous infusion.

                  MANAGEMENT

  1. Vitamin supplement can be given parenterally
  2. gradual introduction of fluids and diet as her condition improve
  3. The mother is encourage to rest and may be cared for in a single room
  4. Mild sedative may be prescribed by the physician,if the mother appear agitated
  5. Small palatable meals on regular basis help to encourage the mother to regain her appetite
  6. Eating a dry biscuit or cracker with a cup of tea before rising in the morning, avoidance of spicy or pungent odours and eating little and often
  7. Good source of vitamin B6 and zinc including whole wheat bread,seeds,nuts,raisins,milk,ginger and chicken.
  8. crystalized ginger,ginger biscuits or ginger tea as well as herbal teas such as camomile,spearmint and peppermint

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