Hyperemesis Gravidarum

Hyperemesis Gravidarum

Definition

This is excessive vomiting in pregnancy which occurs in the first trimester before the 20^th week of gestation and this becomes serious when the patient vomits throughout all day until she empties the stomach contents. The vomitus may contain bile in some cases.

The severe nausea and vomiting leads to dehydration, electrolyte imbalance, weight loss, anorexia which could lead to malnutrition and metabolic disturbance and this requires interventions.

Causes

The causes of hyperemisis gravidarium are unknown but the predisposing factors include;

·              Psychological factors: It occurs in a case of unwantedpregnancy or when a woman wants sympathy or attention from her husband and relatives. More common among educated and nervous women.

·              Endocrine factors (hormones): Rising level of oestrogenand human chorionic gonadotrophin hormones also appear to be significant. The hormones progestin relaxes the cardiac sphincter of the stomach resulting in back reflux of its contents.

·              Multiple pregnancy, hydatidiform mole, acute hydraminos,infective hepatitis, pylonephritis can also predispose to the condition.

Signs and symptoms;

·              Persistent nausea and vomiting which is severe.

·              Weakness, miserable, apathetic i.e. display of emotion

·              Dehydration , emaciated

·              Rapid pulse, low blood pressure.

·              Sunken eyes and dull looking.

·              Dry and inelastic skin.

·              Concentrated and scanty urine and this contains acetone, breath is offensive and smell of acetone as well.

·              Dry furred tongue with cordes on the teeth, dry and cracked sore lips.

·              Hypotension, proteinuria, jaundice, delirius and coma, and death may supervenes

Medical management

There is need for prompt and adequate treatment due to the seriousness of the condition.

·              The patient is admitted in the hospital,

·              History is taken and physical examination by the doctor in order to rule out other causes of vomiting e.g. Hepatitis, hydratidform mole, UTI etc.

·              Rehydrate and correct electrolyte imbalance through IV. Infusion Hypoglacaemia and electrolyte in balance are mainly corrected.

·              Oral fluid is to be suspended for about 24 hours to rest the stomach.

·              Drug such as Antiemetic some of which have sedative effect such as largactil 25mg is given or avomine 25mg and this is done with care because of possible effects on the developing embryo

·              Multivitamins, iron and daraprim are also given

·              Fluid balance record is kept.

·              Record of vomitus is separately maintained.

Nursing Management

The patient is usually miserable and feels sorry for herself.

1.           The midwife should show love, understanding and empathy to the patient to allay her fear. Be tactful and firm in dealing with her.

2.           Complete bed rest, daily bed baths, oral care and care of pressure area.

3.           Strict intake and output chart is maintained.

4.           Urine is tested daily for protein, acetone, bile and chloride and specific gravity is also noted. Record of the findings is done.

5.           Vital signs are monitored and recorded. Report on any deviation from normal.

6.           If she has constipation mild apparent such as magnesium chloride may be given under doctor’s prescription.

7.           Weigh the woman on admission and on alternative days.

8.           The  role  of  the  husband  is  important  in  the  care  of  the woman.

She can commence on oral diet if vomiting has stopped for 24 hours. Easily digestible food served in attractive manner. Give food that she can tolerate, small at frequent intervals. Avoid fried foods and oily foods. Give fruit juice.