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Vomiting in pregnancy

Vomiting in pregnancy. Dr sadiqa. Learning objectives. Define hyperemesis gravidarum Etiology Diagnosis Other causes of vomiting Select appropriate investigation Complications of HG Outline the management of HG. Hyperemesis Gravidarum.

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Vomiting in pregnancy

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  1. Vomiting in pregnancy Dr sadiqa

  2. Learning objectives • Define hyperemesis gravidarum • Etiology • Diagnosis • Other causes of vomiting • Select appropriate investigation • Complications of HG • Outline the management of HG

  3. Hyperemesis Gravidarum • Definition : sever type of vomiting of pregnancy which has got deleterious effect on the the health of the mother and /or incapacitates her in day to day activities.

  4. Incidence: 0.8-1.5% now less reduction in unplanned preg better application of FPM potent antihistaminics

  5. Aetiology • Endocrine - Hcg, Estrogen, progesterone, PRL • Infection - helicobacter pylori • Upper GI dysmotility • Psychological • Dietetic deficiency –B6 B1 • Familial predisposition

  6. Pathology • Vomiting – dehydration – carbohydrate starvation – depletion of glycogen stores – mobilization of fat stores- production of ketone bodies – excreted thro’ urine & breath. • Increased tissue protein metabolism- increased BUN • Prolonged vomiting - hypoglycemia, hypokalemia hyponatremia , hypoproteinemia.

  7. Biochemical : Alkalosis, Hyponatremia, Hypokalemia Hypochloremia. • Brain : Small Hge in the hypothalamus • Liver :transient hepatic dysfunction-cetrilobular fatty infiltration with out necrosis. • Kidney : ARF can develop due to dehydration. • Vascular : Hemo-concentration, mild leucocytosis, eosinophelia

  8. Clinical features • Vomits frequently prolonged and severe, strong aversion for food and Ptyalism. • Diminished quantity of urine • Epigastric pain • Constipation

  9. Signs of dehydration • Dry coated tongue • Sunken eye, rise in temp • Loss of skin turgor • Ketotic odour of breath • Loss of skin elasticity • Tachycardia / Hypotension • 5% wt. loss may be there • Severe case jaundice may develop.

  10. Causes of vomiting • Related to pregnancy: morning sickness (emesis gravidarum) hyperemesis gravidarum continuation / reapprearance of vomiting acute fulminant preeclampsia

  11. Causes of vomiting • Associated with pregnancy: Medical: UTI, hepatitis, diabetic ketoacidosis, pylelonephritis, intestinal infestation, uremia. Surgical: appendicitis, peptic ulcer, cholecystitis, pancreatitis, intestinal obstruction. Gynecological : twisted ovarian tumor, red degeneration of fibroid.

  12. Investigation • Urine analysis: quantity – small, dark color high sp gravity presence of acetone absence of chloride

  13. Raised hematocrit • BUN – S creatinine • S. electrolyte • LFT • TFT : transient phase of thyroid dysfunction • USG –Viability no. of fetus, Role out molar Adnexal pathology • Retinal Hge, Retinal detachment • ECG

  14. Complications • Electrolyte imbalance • Liver dysfunction • Depression • Hyperalimentation • Diaphramatic rupture • Esophageal rupture (Boerhaave syn.) • Acute kidney injury

  15. Mallory Weiss tears • wernicke’s encephalopathy • Pontine mylinosis • Peripheral neuritis • Hypoprothrombenemia - Vit K def. • Korsakoff’s psychoses

  16. Management • Maintenance of hydration • Control vomiting-promethazine,triflupromazine vitB6,doxylamine, metaclopromide • Correct fluid & electrolyte imbalance • Prevent complications • Care of pregnancy

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