1.0 Gestational Conditions: Hyperemesis Gravidarum

Hyperemesis Gravidarum

• ketosis

• weight loss

• most severe form of N|V

  • begins by 9-10 weeks o

  • gestation

  • peaks at 11-13 weeks

  • resolves by 12-14 weeks

Characterized by persistent N|V

associated with ________and

_________

• volume depletion

• electrolytes and acid-base

• imbalances

• nutritional deficiencies

• death

• Hormonal changes

• Gastrointestinal Dysfunction

• Hepatic dysfunction

• Lipid alterations

• Infection

• Vestibular and Olfaction

• Genetic

HG PATHOPHYSIOLOGY

transient hyperthyroidism

High HCG levels that cause __________________

thyroid gland thyroid stimulating hormone (TSH)

• Transient hyperthyroidism

• 2nd trimester

HORMONAL CHANGES

• HCG can physiologically stimulate the ______________ receptor.

• HCG levels peak in the first trimester.

• ______________ of hyperemesis gravidarum occurs

• thyroid function normalizes by the middle of the ____________ without antithyroid Treatment

Gastrointestinal Dysfunction

The stomach pacemaker causes rhythmic peristaltic contractions of the stomach.

rhythmic peristaltic contractions

GASTROINTESTINAL DYSFUNCTION

• The stomach pacemaker causes ___________________ of the stomach.

Abnormal myoelectric activity

• Gastric dysrhythmias

__________________ may cause a variety of __________ (tachygastrias and bradygastrias): MORNING SICKNESS / NAUSEA

• Elevated estrogen and progesterone levels

• Thyroid disorders

• Abnormalities in vagal and sympathetic tone

• Vasopressin secretion in response to intravascular volume perturbation

Mechanisms that cause gastric dysrhythmias include:

Hepatic Dysfunction

• Liver disease (mild serum transaminase elevation)

• Impairment of mitochondrial fatty acid oxidation

• Due to the accumulation of fatty acids in the placenta and subsequent generation of reactive oxygen species

Liver disease

Mitochondrial fatty acid oxidation

Accumulation of fatty acids in the placenta

HEPATIC DYSFUNCTION

• ____________(mild serum transaminase elevation)

• Impairment of ______________________________

• Due to the ________________________ and subsequent generation of reactive oxygen species

Lipid Alteration

• Triglycerides

• Total cholesterol

• Phospholipids

________?__________

• Higher levels of ________, _________, _________

• This may be related to the abnormalities in hepatic function in pregnant women.

Infection

Helicobacter pylori

Active Peptic Ulcer

HYPEREMESIS GRAVIDARUM

_______?_________

• _________ is a bacterium found in the stomach that may aggravate nausea and vomiting in pregnancy

• _________ caused by _______ infection

Vestibular and Olfaction

Hyperacuity of the olfactory system

• The smell of cooking food, particularly meats, triggers nausea.

Genetic

A study was performed looking at 544,087 pregnancies from Norway ’ s mandatory birth registry from 1967 to 2005

• daughters born from a pregnancy complicated by hyperemesis had a 3% risk of having hyperemesis in their own pregnancy.

• Women who were born after an unaffected pregnancy had a risk of 1.1%

• Nausea

• Vomiting

• Ptyalism

• Fatigue, weakness, dizziness

Hyperemesis Gravidarum Symptoms:

• Previous pregnancies with hyperemesis gravidarum

• Greater body weight

• Multiple gestations

• Trophoblastic disease

• Nulliparity

Hyperemesis Gravidarum risk factors:

Acupressure

Hypnosis

Hyperemesis Gravidarum: Med Care

• dietary recommendations

• support

• Alternative therapies

• Note: Mild Nausea can be relieved by acupressure on your wrist

• Vitamin B-6

• Doxylamine

• Ginger capsules

• Metoclopramide

• Promethazine

• Ondansetron

Hyperemesis Gravidarum: Medications

10-25mg

3-4x/day

Vitamin B6

• Dose:

• Frequency:

12.5mg

3-4x/day

Doxylamine

• Dose:

• Frequency:

250mg

4x/day

Ginger Capsules

• Dose:

• Frequency:

5-10mg O.R

q8h

Metoclopramide (orally)

• Dose:

• Frequency:

12.5mg

Oral or rectal

q4h

Promethazine

• Dose:

• Route

• Frequency:

Dimenhydrinate

50-100mg Orally

q4-6h

Promethazine or?

4-8mg

Orally or IV

q8h

Ondansetron

• Dose:

• Route:

• Frequency:

• Parenteral or enteral route

• Total Parenteral Nutrition

Nutritional Supplementation:

• __________________

• The standard method has been

Emetogenic

Iron

High Protein

Crackers

Carbonated Beverages

DIET:

• Eat when hungry, regardless of normal meal times

• Eat frequent small meals

• Avoid fatty and spicy foods and __________foods or smells

• Increase intake of bland or dry foods

• Eliminate pills with _____

• __________ snacks are helpful

• ________in the morning

• Increase intake of _____________

• Herbal teas containing peppermint or ginger, other ginger-containing beverages, broth, crackers, unbuttered toast, gelatin, or frozen desserts

• Preconception use of prenatal vitamins may decrease nausea and vomiting associated with pregnancy

• Decreased Activity

• Increase Rest

• Fresh outdoor air

Activity: