Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
GRAVIDARUM
INTRODUCTION
At least 80% of women experience
nausea &vomiting.
The term morning sickness is often used
to describe this condition when
symptoms usually disappear after the
first trimester.
severe form ( hyperemesis gravidarum )
Dehydration
Electrolyte imbalance
Need for hospitalization
Definitions
o Morning sickness: is the nausea felt by about 50% of
pregnant women on getting up in the morning.
o Emesis gravidarum: Actual vomiting in the morning.
o These two conditions usually start between the 4th and
6th weeks of pregnancy and improves or disappears
about the 12 th week.
o Hyperemesis gravidarum: The vomiting is not confined
to the morning but it is repeated throughout the day
until it affects the general condition of the patient.
Diagnosis
Symptoms:
o The patient cannot retain anything in her
stomach, vomiting occurs through the day
and night even without eating.
o Thirst, constipation and oliguria.
o In severe cases, vomitus is bile and/ or
blood stained.
o Finally, there is manifestations of
Werniches encephalopathy as drowsiness,
nystagmus and loss of vision then coma.
Diagnosis
Signs:
Manifestations of starvation and
dehydration:
* Loss of weight.
* Sunken eyes.
* Dry tongue and inelastic skin.
* Pulse: rapid and weak.
* Blood pressure: low.
* Temperature: slight rise.
Differential diagnosis
Other causes of vomiting as:
* cholecystitis,
* appendicitis,
* pyelonephritis,
* gastroenteritis,
* gall bladder diseases,
* complicated ovarian tumours.
CAUSES
While there are numerous theories
regarding the cause of HG, the cause
remains controversial.
It is thought that HG is due to a
combination of factors which may
vary between women and include:
genetics, body chemistry, and overall
health.
Aetiology
1. Hormonal: high human chorionic
gonadotrophin (hCG) stimulates the
chemoreceptor trigger zone in the brain
stem including the vomiting center. This is
the most accepted theory and proved by
the higher frequency in the conditions
where the hCG is high as in:a. early in pregnancy,
b. vesicular mole and
c. multiple pregnancy.
Aetiology
2.Allergy: to the corpus luteum or the
released hormones.
Aetiology
3. Deficiency of:
a. adrenocortical hormone
and /or,
b. vitamin B6 and B1
Aetiology
4.Nervous and psychological:
a.due to psychological rejection of
an
unwanted pregnancy,
b. fear of pregnancy or labour so it
is
more common in
primigravidae.
PATHOPHYSIOLOG
Y
SOURCE
AETOLOGY
PLACENTA
CORPUS
LUTEUM
hCG
PLACENTA
OESTROGEN
PROGESTERONE
PATHOPHYSIOLOGY
GIT
Distention of
gastrointestinal tract
Crossover with TSH,
causing gestational
thyrotoxicosis
Decreased gut mobility
Elevated liver enzymes
Decreased lower
esophageal sphincter
pressure
Increased levels of sex
steroids in hepatic
portal system
HELICOBACTER
PYLORI
PSYCHOLOGICAL
Possible effect of
culture and
environment
COMPLICATIONS
1. Weight loss
2. Dehydration
3. Metabolic acidosis from
starvation
4. Alkalosis from loss of HCL
5. Hypokalemia (electrolyte
imbalance)
Pathological Changes
These are the same as in prolonged
* Liver: small fatty infiltration.
* Kidney: fatty degeneration of the convoluted
tubules.
* Heart: small subendocardial and subpericardial
haemorrhages.
* Brain: congestion and petechial haemorrhages in
the brain stem resembling that of Wernickes
encephalopathy.
Eye: optic neuritis and retinal haemorrhage.
* Peripheral nerves: degeneration
Pathological Changes
Blood:
Hypovolaemia and haemoconcentration.
Hyponatraemia, hypokalaemia and hypochloraemia.
Increased blood urea.
Hyperbilirubinaemia (due to liver damage).
Acidosis.
Urine:
Oliguria.
Increased specific gravity.
Decreased chloride.
Albuminuria.
Ketonuria.
MANAGEMEN
T
Management
Intravenous fluids
* Oral feeding is prevented for 24-48 hours.
* Three litres of glucose 5% is given by
rapid infusion over 2-3 hours.
* Maintain intravenous glucose 5% and
saline therapy.
* When vomiting is controlled frequent
gradual small carbohydrate diets are
started.
Management
Drugs
* Adrenocortical preparations.
* Vit. B6 and Vit. B1.
* Antihistaminics that have antiemetic effect as
meclozinehydrochloride 25-50 mg twice daily. A
preparation contains both meclozine
hydrochloride + pyridoxine hydrochloride (vit.
B6) is of good benefit.
* Phenothiazine (chlorpromazine=largactil) 5-10
mg three times daily has a tranquilliser and
antiemetic effect.
2.promoting comfort
Hygiene measures and oral care
Pay special attention to the
environment making sure to keep
the area free of pungent odors
As the Client's nausea and vomiting
subside, gradually introduce oral
fluid & foods in small amounts
Monitor intake and output
Observation
* Vomiting: frequency, amount, colour and
contents.
* Vital signs: pulse, temperature and blood
pressure.
* Fluid: intake and output.
* Urine analysis: specific gravity, albumin,
ketone bodies,chloride and bile pigments.
* Blood: urea, electrolyte and liver function
tests.
* Eye: examination of the fundus.
GEJALA
Tingkatan I
Tingkatan II
Tingkatan III
Keadaan umum jelek, somnolen, koma
Syok
Kx : encefalopathy Wernicke
TERIMA KASIH