HYPEREMESIS

GRAVIDARUM
Deviana S. Riu

DEFINITION

Nausea & vomiting experienced by

pregnant women in early pregnancy who
did not respond to diet and antiregulation emetik
Often experienced by:

Multiple pregnancy
Molahydatidiform

Linked with:

Weight loss
Dehydration
Acidosis
Alkalosis
Hypokalemia

Lab :

Light Hyperbilirubinemia
liver disfunction

ETIOLOGI

Hormon hCG

Most common top level associated with

hyperemesis onset
Particularly experienced by women with
high hCG levels (Gemelli, molahidatidosa)
Mechanism?
Stimulation

of secretion of digestive tract

Stimulation of thyroid function, because the
structure of hCG is similar to the TSH

Other hormones

Progesteron ?
Estrogen :
HG is mainly found in women with high
estrogen conditions such as high BMI
Treatment with estrogen: effects of nausea
and vomiting
Estrogen causes peristaltic bowel and
gastric emptying slow resulting an
accumulation of fluid due to increased steroid
hormones.
pH changes cause gastrointestinal
helycobacter pylori infection, which is also
associated with symptoms of indigestion

 Thyroid

hormone
Thyroid hormone receptors sensitive to hCG,
resulting in decreased TSH and free T3 and
T4 increased
Adrenal cortex
Low cortisol linked to HG
Response to treatment with therapeutic
corticosteroid
Leptin
Reduces appetite and works with cortisol,
thyroid hormone
Growth hormone and prolactin?

Immunology

GI tract

IL-6, TNF alfa. T-helper2, imunoglobulin, C3,

C4
Helycobacter pylori

Vitamin deficiensy : thiamin & vit.K

Psychological factors

Hyperemesis gravidarum is divided into several degrees:

Degree 1
Continuous vomiting (vomiting> 3-4
times / day, and prevent the entry of food
or drink for 24 hours) which caused the
mother to be weak, no appetite, weight
loss (2-3 kg in 1-2 weeks), heartburn,
pulse increased to 100x permenit,
systolic blood pressure decreased, turgor
decreases and sunken eyes

Degree 2
Patients seem more vulnerable and do
not care about the surroundings, small
and rapid pulse, temperature sometimes
rises and eyes slightly yellow. Weight
loss and the eyes become sunken, blood
pressure falls, blood coagulation, urine
decreased, and constipation. In the
breath may smell of acetone

Degree 3
General state of more severe, stop vomiting,
decreased consciousness to coma, small and
rapid pulse, temperature increases, and blood
pressure down. In the newborn baby may
occur with symptoms of Wernicke's
encephalopathy: nistagmus, double vision,
and mental changes. This situation is due to
lack of nutrients, including vitamin B complex.
If Icterus means existing liver disorders

EXAMINATION

Urine
ketones, bilirubinuria
Blood
blood electrolytes, urea, creatinine,
glucose, liver function, thyroid function
USG
gestation, a multiple gestation, fetal
abnormalities , molar pregnancy.

MANAGEMENT

Set diet: small portions but frequently and

avoid foods that trigger vomiting
Treatment:
Vitamin B6
Antiemetik: promethazine (25 mg/6jam),
prochlorperazine, chlorpromazine
For severe cases: metoclopramide (10
mg /6 hours), ondansetron
Overcome dehydration, electrolyte deficits
and acid base balance: crystalloid IV fluids

KOMPLIKASI

Mallory Weiss syndrome

A tear in the esophagus

Pneumothorax
Pneumomediastinum

Epistaksis
Wernicke encephalopathy (blindness,
seizures and coma)

DIFFERENTIAL DIAGNOSIS

Gastroenteritis
Cholecystitis
Pancreatitis
Hepatitis
Ulcer peptik
Acute fatty liver

Thank You