HYPEREMESIS

GRAVIDARUM

OBSTETRIC & GYNECOLOGY DEPARTMENT

MEDICAL FACULTY BRAWIJAYA UNIVERSITY/SAIFUL ANWAR HOSPITAL
MALANG
HYPEREMESIS GRAVIDARUM

• Severe nausea and excessive vomiting starting before the end of the 22 nd week of gestation (WHO,2016)
• Affect 0.3-2% of pregnant woman
• If untreated  maternal morbidity and adverse birth outcome
• Lead to : dehydration, electrolyte and acid-base imbalance, nutritional deficiency, ketonuria, loss more than 5%
body weight
• Excess salivation, Vitamin B1 and mineral deficiencies, gastroesophageal reflux symptoms, abnormal liver
function test
• Morbidity : acute kidney injury, liver dysfunction, pneumomediastinum, ruptured esophagus, Wernicke’s
encephalopathy, psychological distress
• Poor neonatal outcome : low birth weight, preterm birth, fetal death, small for gestational age
Mual dan muntah pada wanita hamil :

• ≥3x/hari
• Disertai keton dalam urin / aseton dalam darah
( dehidrasi dan perubahan elektrolit)
• Berat badan menurun >3 kg atau 5% dari BB
sebelum hamil
• Tak dapat ditemukan penyebab lainnya
EPIDEMIOLOGI

• 75% wanita hamil mual

• 50% mual-muntah
• 0,5-1% Hiperemesis Gravidarum (HG)
• Onset 4-6 minggu, puncak 8-12 minggu,
• Reda < 20 mgg
FAKTOR RESIKO

• Obesitas
• Nulipara
• HG sebelumnya (67% rekuren)
• Janin perempuan
• Riwayat migrain
• HCG level tinggi (plasenta yg besar pada multiple pregnancy & mola)
• Tingginya kadar estradiol (wanita yg mengalami mual –muntah wkt konsumsi pil hamil kemungkinan jg
mual-muntah saat hamil)
• Merokok dihubungkan dengan rendahnya kadar HCG & estradiol maka insiden HG rendah
PREGNANCY UNIQUE QUANTIFICATION OF EMESIS (PUQE) SCORE
PATHOGENESIS

1. Genetic predisposition
2. Placentally mediated mechanism
3. Reproductive hormones
4. Human chorionic gonadotropin (hCG)
5. Progesterone and estrogen
6. Gastointestinal dysmotility
7. Helicobacter pylori
8. Serotonin
9. Thyroid hormones
 KLASIFIKASI SECARA KLINIS

Tingkat I

• Muntah yang terus-menerus, intoleransi terhadap makanan

dan minuman, BB menurun, nyeri epigastrium, muntah
pertama keluar makanan, lendir dan sedikit cairan empedu,
dan yang terakhir keluar darah. Nadi meningkat sampai 100
kali per menit dan tekanan darah sistolik menurun. Mata
cekung dan lidah kering, turgor kulit berkurang, dan urin
sedikit terapi masih normal.
 KLASIFIKASI SECARA KLINIS

Tingkat II

• Gejala lebih berat, segala yang dimakan dan diminum

dimuntahkan, haus hebat, subfebril, nadi cepat dan lebih dari
100 - 140 kali per menit, tekanan darah sistolik kurang dari
80 mmHg, apatis, kulit pucat, lidah kotor, kadang ikterus,
aseton, bilirubin dalam urin, dan berat badan cepat menurun.
 KLASIFIKASI SECARA KLINIS

Tingkat III

• Walaupun kondisi tingkat III sangat jarang, yang mulai

terjadi adalah gangguan kesadaran (delirium-koma), muntah
berkurang atau berhenti, tetapi dapat terjadi ikterus, sianosis,
nistagmus, gangguan jantung, bilirubin, dan proteinuria
dalam urin.
•.
 TREATMENT

• improving symptoms
• minimizing risks to mother and fetus
• Treatment modalities depend on the severity of the symptoms
• dietary changes
• intravenous fluid rehydration (including electrolytes, vitamins, and
thiamin)
• pharmacologic treatment
• hospitalization.
 HOSPITALIZATION

• In HG patients with more severe dehydration or ketonuria, inpatient

admission is required.
• Maintaining hydration or, in the case of severe dehydration achieving quick
and sufficient rehydration, is the most important intervention.
• Volume and electrolyte replacement (at least 3 L/day),
• correction of potential electrolyte imbalance
• administration of vitamins
• parenteral administration of carbohydrate and amino acid solutions (about
8400 to 10,500 kJ/day)
• Rehydration is most easily and quickly accomplished intravenously and this
reduces adverse symptoms very effectively.
NON-PHARMACOLOGIC TREATMENT

1. Dietary modifications
2. Ginger
3. Acupressure/acupuncture
4. Thiamine supplementation
5. Intravenous fluid rehydration
PHARMACOLOGIC TREATMENT

1. Antihistamines
2. Antiemetics
3. Benzamides
4. Serotonin receptor antagonis
5. Anti-reducing agents
6. corticosteroids
 DIETARY MODIFICATIONS

• Dietary changes are basic for the initial therapy for NVP.
• Eating small amounts of food several times a day instead of large meals has been
recommended
• The meals should be bland and low in fat as fatty foods may further delay gastric
emptying and spicy foods may trigger nausea
• Eating meals that are high in protein and low in carbohydrates
• taking in more liquids than solids may also improve the gastric dysrhythmias
associated with NVP
• Drinking small volumes of fluids between meals including beverages with
electrolytes is also advisable
THANKYOU