Hyperemesis Gravidarum: Treatment, Management and Complication
What is Hyperemesis Gravidarum?
Hyperemesis gravidarum (HG) is a complication of pregnancy that is characterized by severe nausea and vomiting such that weight loss and dehydration occur. It is a severe type of vomiting of pregnancy which has got deleterious effect on the health of the mother &/or incapacitates her in day to day activities.
Investigation of Hyperemesis Gravidarum:
It includes the following:
- USG of lower abdomen: To confirm pregnancy and to exclude the other cause (H. mole & twin pregnancies).
- Urine analysis: Small in quantity, dark color, high specific gravity with acid reaction, occasional presence of acetone with protein & bile pigment.
- Serum electrolytes: decrease sodium, potassium and chloride.
- Blood urea: may be raised.
- Blood glucose: Hypoglycaemia.
- Blood: Hb%, TC, DC, ESR.
- Liver enzymes.
- RBS.
- ECG.
Treatment and Management of Hyperemesis Gravidarum:
General management:
- Urgent hospitalization.
- Nothing by mouth for at least 24 hours.
- Oral route (both medication & food) should be used after significant improvement of the patient).
- Amount of fluid required per day: previous days output + 3000 ml with 200 ml of 25 dextrose and 2 ml of vitamin B, 2 ml of vitamin c are given per day.
- Intravenous fluid.
- Electrolyte containing fluid is preferable.
- Cholera saline or Hartman’s solution.
- Catheterization: To monitor urine output.
- Encourage food and fluid high in potassium magnesium level.
- Monitor laboratory values.
- Maintain intake and output chart.
- Correction of fluid and electrolyte balance.
- Measure daily weight.
Specific Management:
- Anti-emetic: promethazine (25 mg IM tds).
- Hydrocortisone drip
- Nutritional support.
Complications of Hyperemesis Gravidarum:
The main risks to women with hyperemesis gravidarum are-
- Dehydration,
- Electrolyte imbalances,
- Shock,
- Acute renal failure.
Less common but severe complications of hyperemesis gravidarum include:
- Ruptured esophagus from forceful vomiting,
- Collapsed lung,
- Liver disease,
- Blindness,
- Brain swelling from malnutrition,
- Kidney failure,
- Blood clots,
- Seizures,
- Coma,
- Death.
Biochemical Changes in Hyperemesis Gravidarum:
It includes the following:
- Increase blood urea & uric acid,
- Hypoproteineamia,
- Hypovitaminosis.
More questions related to this article:
- What do you mean by hyperemesis gravidarum?
- Define hyperemesis gravidarum.
- What are the investigations of hyperemesis gravidarum?
- How will you manage a case of hyperemesis gravidarum?
- What are the complications of Hyperemesis Gravidarum?
- What are the biochemical changes take place in hyperemesis gravidarum?
