HYPEREMESIS GRAVIDARUM

• 9-10 weeks

• 11-13 weeks

• 12-14 weeks

Hyperemesis gravidarum

• begins by:

• peaks at

• resolves by

persistent NV

• ketosis

• weight loss

HG is Characterized by _________associated with________and ________

• volume depletion

• electrolytes and acid-base imbalances

• nutritional deficiencies

• death

• hormonal

• Gastrointestinal dysfunction

• Hepatic dysfunction

• Lipid alterations

• Infection

• Vestibular and olfaction

• Genetic

what are the 7 pathophysiology of Hyper emesis gravidarum

Sociocultural, Biological, psychological

HG is affected by 3 interacting factors which are

Transient Hyperthyroidism

• Thyroid gland’s thyroid stimulating hormone Receptor

High HCG levels can cause ____________________

• HCG can physiologically stimualte the __________ of the _____________

• first trimester

• middle of 2nd trimester , antithyroid treatment

HCG peaks in _____________

Thyroid function normalized by ___________ without _________

approx. 3 cycles per minute

• tachygastria

• bradygastria

Normal Gastric Rhythm is

• Fast Rhythm = _______

• IF Slower = _______

Stomach pacemaker

What controls rhythmic peristaltic contractions of the stomach?

Gastric dysrhythmias

• Tachygastrias

• bradygastrias

What happens when gastric myoelectric activity becomes abnormal?

Vasopressin

If vomiting causes volume loss the body releases

• elevated estrogen / progesterone

• thyroid disorders

• abnormalities in vagal and sympathetic tone

• vasopressin secretion in response to intravascular volume perturbation

GASTROINTESTINAL DYSFUNCTION

• mechanisms that cause gastric dysrhythmias are?

Intravascular volume perturbation

Vasopressin is released in response to________

Mild serum transaminase elevation

in liver disease, there is _____________ elevation

• accumulation of fatty acid in placenta

• generation of reactive oxygen species

What causes impairment of mitochondrial fatty acid oxidation?

Impairment of mitochondrial fatty acid oxidation

• accumulation of fatty acid in placenta

• generation of reactive oxygen species

Causes?

Increase triglycerides, total cholesterol, phospholipids

What lipid changes occur in hyperemesis gravidarum?

Lipid alteration

Can be related to abnormalities in hepatic function in pregnant women

Helicobacter pylori.

What bacterium may aggravate nausea and vomiting in pregnancy?

Active peptic ulcer

What complication of H. pylori can further worsen vomiting?

hyperacuity of the olfactory system

pathophysiology of Vestibular and Olfaction In HG

Cooking foods, particularly meats

What type of smells commonly trigger nausea?

3% risk

What is the risk of HG in daughters whose mothers had HG?

1.1 %

What is the risk of HG in daughters whose mothers did not have HG?

Nausea, vomiting, ptyalism, fatigue, weakness, dizziness.

What are the main symptoms of hyperemesis gravidarum?

• previous pregnancy with HG

• Nulliparity

• multiple gestation

• trophoblastic disease

• Greater body weight

Risk Factors of HG

• Vitamin b6

• doxylamine

• ginger capsules

• metoclopramide

• Promethazine

• Dimenhydrinate

• Ondansetron

Medications for HG

10-25 mg 3-4

Vitamin b6

12.5 mg 3-4

Doxylamine

250 mg 4

Ginger capsules

5-10 mg every 8 hours

Metoclopramide

12.5 Orally or Rectally every 4-5 hours

Promethazine

50-100 mg orally every 4-6 hours

Dimenhydrinate

4-8 mg orally or IV every 8 hours

Ondansetron

• Parenteral / enteral route

• standard: TPN

Nutritional Supplementation for HG

eat when hungry, regardless of normal meal times

eat frequent small meals

avoid fatty and spicy foods and emetogenic foods or smells

Eliminate pills with iron

Increase intake of bland or Dry foods

crackers in the morning

high protein snacks

Increase intake of carbonated Beverages

herbal teas containing peppermint or ginger

other ginger containing beverages, broth, crackers, unbuttered toast, gelatin, frozen desserts

Preconception use of prenatal vitamins

What should be the Diet of woman with HG

Hyperemesis gravidarum

what condition should pills containing iron be avoided?