EpidemiologyItis more common in:PrimigravidaMultiple pregnancyHistory of previous hyperemesisMother or sister with HGThepresenceoftrophoblastic diseasePreviousintolerancetooral contraceptivesYoung maternal age under the age of 20Lowtomiddle socioeconomic classLowerlevelsofeducationCarrying a female fetusNo previous completed pregnanciesObesityHistoryof infertilityCorpus luteum in right ovaryNonsmokersWomenpronetotravel sicknessMedical complications of hyperthyroid disorders, psychiatric illness, gastrointestinaldisorders, pregestational diabetes, and asthmaItis less common withMaternal age older than 30 yearsMaternal smokingUnmarriedmothers
Epidemiology It is more common in: • Primigravida • Multiple pregnancy • History of previous hyperemesis • Mother or sister with HG • The presence of trophoblastic disease • Previous intolerance to oral contraceptives • Young maternal age under the age of 20 • Low to middle socioeconomic class • Lower levels of education • Carrying a female fetus • No previous completed pregnancies • Obesity • History of infertility • Corpus luteum in right ovary • Nonsmokers • Women prone to travel sickness • Medical complications of hyperthyroid disorders, psychiatric illness, gastrointestinal disorders, pregestational diabetes, and asthma It is less common with • Maternal age older than 30 years • Maternal smoking • Unmarried mothers
Degree of Nausea and VomitingDuring PregnancyINEARLYPREGNANCY-Relatedtopregnancy- Mild --- in evening or morning ---- mild emesis gravidarum- Moderate-with meals----moderateemesis gravidarum- Severe --- frequent more than 10 times / day-without affection of general condition of pregnancy---severeemesisgravidarum-with affection of general condition of pregnancy ----- HYPEREMESISGRAVIDARUM=hyperemsisgravidarumwithoutcomplications=hyperemsisgravidarumwith complications-Other causes of nausea and vomitingINLATEPREGNANCY-HYPEREMESISGRAVIDARUM-Other causes of nausea andvomiting
Degree of Nausea and Vomiting During Pregnancy IN EARLY PREGNANCY - Related to pregnancy – Mild - in evening or morning - mild emesis gravidarum – Moderate – with meals - moderate emesis gravidarum – Severe - frequent more than 10 times / day - without affection of general condition of pregnancy-severe emesis gravidarum - with affection of general condition of pregnancy - HYPEREMESIS GRAVIDARUM = hyperemsis gravidarum without complications = hyperemsis gravidarum with complications - Other causes of nausea and vomiting IN LATE PREGNANCY -HYPEREMESIS GRAVIDARUM - Other causes of nausea and vomiting
hyperemesis gravidarum without complicationswith affect on general condition of pregnant increase pulseover 100 + Decrease systolic blood pressure below 100 +increase temp above 38 degree + dehydration like dry tongue,sunken eyes +ketosishyperemesis gravidarum with complicationsEsophageal rupture or perforationPneumothorax and pneumomediastinumWernicke encephalopathy or blindnessHepatic diseaseSeizures, coma, or deathOthers complications include renal failure, pancreatitisdeep venous thrombosis, pulmonary embolism, central pontinemyelinolysis, rhabdomyolysis, Vitamin K deficiency andcoagulopathy, and splenic avulsion
hyperemesis gravidarum without complications • with affect on general condition of pregnant increase pulse over 100 + Decrease systolic blood pressure below 100 + increase temp above 38 degree + dehydration like dry tongue, sunken eyes + ketosis hyperemesis gravidarum with complications • Esophageal rupture or perforation • Pneumothorax and pneumomediastinum • Wernicke encephalopathy or blindness • Hepatic disease • Seizures, coma, or death • Others complications include renal failure, pancreatitis, deep venous thrombosis, pulmonary embolism, central pontine myelinolysis, rhabdomyolysis, Vitamin K deficiency and coagulopathy, and splenic avulsion
SeverityAssessment of severity by checking forketones is important as severity determinesmanagement
Severity Assessment of severity by checking for ketones is important as severity determines management
Emesis GravidarumHyperemesis GravidarumRareCommonConfined to mealsRepeated throughout daysevere and persistentDoes not affectgeneral conditionAffectsgeneral conditionweightloss,dehydration,nutritionaldeficiencies, electrolyte imbalance,pHimbalance (metabolic acidosis), and possibleliverdamageResolvesaround12weeksProgressive course even fatalunlesseffectivetreatmenteven withouttreatmentOften persists for the duration of pregnancyAlwaysrequireshospitalizationRarelyneedshospitalizationNeed oral fluidNeedenteralorarenteralfluid
Emesis Gravidarum Hyperemesis Gravidarum Common Rare Confined to meals Repeated throughout day severe and persistent Does not affect general condition Affects general condition weight loss, dehydration, nutritional deficiencies, electrolyte imbalance, pH imbalance (metabolic acidosis), and possible liver damage Resolves around12 weeks even without treatment Progressive course even fatal unless effective treatment Often persists for the duration of pregnancy Rarely needs hospitalization Always requires hospitalization Need oral fluid Need enteral or arenteral fluid