Hiperemesis Gravidarum

Posted by Diana
On Sunday, February 7, 2010

Definition
Hyperemesis gravidarum is excessive nausea and vomiting that day’s work disrupted and the general condition became worse. Nausea and vomiting are the most common disorders found in pregnancy trimester I. approximately 6 weeks after the last period for 10 weeks. Approximately 60% -80% primigravida and 40% -60% multigravida experiencing nausea and vomiting. However, these symptoms become more severe only in 1 in 1000 pregnancies.
Certain unknown causes hyperemesis gravidarum, but several factors influence among others:
- Predisposing factors, namely primigravida, hydatidiform mole and multiple pregnancy.
- Organic factors, ie allergies, entry khorialis villi in circulation, metabolic changes due to pregnancy, and decreased resistance mothers.
- Psychological factors
Feelings of nausea due to increased estrogen levels. Nausea and vomiting continuously can cause dehydration, hyponatremia, decreased urine chloride, which further reduces occurred hemokonsentrasi blood perfusion to the tissue and cause toxic tertimbunnya. The use of fat reserves and karbohidtrat cause incomplete fat oxidation to occur ketosis. Vomiting and hypokalemia due to excessive elserasi further increase the frequency of vomiting and liver damage. Mucous membranes of the esophagus and stomach can tear (Mallory-Weiss syndrome) that gestational hemorrhage.

Clinical Manifestation
According to the severity of symptoms, hyperemesis gravidarum were divided into 3 levels, namely:
Level I, constantly vomiting yangmempengaruhi general conditions, causing weakness, no appetite, BB decreased, and pain epigastrum. Patient’s pulse rate rose by about 100X/mnt, TD sistollik down, reduced skin turgor, dry tongue, and sunken eyes.
Level II, the patient appeared weak and apathetic, dirty tongue, small and rapid pulse, temperature sometimes rose, and the eyes slightly ikterik. BB patient falls, arising hypotension, hemokonsentrasi, oliguria, constipation, and halitosis acetone.
Level III, awareness of patients decreased from somnolen into a coma, vomiting stops, small and rapid pulse, temperature increases, and TD further down.

Examination Support
Examination of blood and urine electrolytes.

Complications
Wernicke encephalopathy with symptoms nistagmus, diplopia and mental changes as well as symptoms of poor heart with the emergence of jaundice.

Diagnosis
From anamnesis, obtained amenorhe, pregnancy signs, and constant vomiting. On examine the patient’s physical condition is weak obtained apathy to coma, the pulse increases until 100x/mnt, the temperature rises, BP down, or there are other signs of dehydration. On examination found blood electrolytes sodium and chloride levels down. On examination of urine levels of chloride and can be found ketones.

Diagnosis Banding
Vomiting due to gastritis, peptic ulcer, hepatitis, cholecystitis, pyelonephritis.

Prevention
The principle of prevention is to treat to prevent emesis hyperemesis.
Information that pregnancy and childbirth are physiological.
Eat a little, but often. Give snack such as crackers, dry bread with the warm up in the morning and before bed. Avoid greasy foods and smells. Food should be in a state of hot or warm.
Regular defecation

Management
When prevention does not work, then the treatment required, namely:
Patients in isolation in a quiet room and bright with good air exchange. Given parenteral calories with 5% glucose in physiological fluids by 2-3 lt / hr.
Diuresis was always controlled to maintain fluid balance.
If during the 24 hours the patient is not vomiting and general condition improved, try to provide drinks and food are gradually added.
Sedatives are given Phenobarbital.
Recommended vitamin B1 and B6 added.
In more severe conditions such as metoclopramide given antimetik, disiklomin, hydrochloric or klorpromazin.
Provide psychological therapies to ensure patients can be cured illness and eliminate the fear of pregnancy and hyperemesis melatarbelakngi conflict.

Prognosis
With good treatment, the prognosis is very satisfying. However, at a level that can cause severe maternal and fetal death.




Category: Disease, Maternity
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