HYPEREMESIS

GRAVIDARUM

Angeli Luz S. Bonaobra

BSN II-1 Group B
 TABLE OF
CONTENTS

What is Hyperemesis Signs and

01 Gravidarum?

Why does it
Symptoms
Treatment
and
03
02 04
happen? Therapeutic
Managemen
t
  is a condition characterized by
severe nausea, vomiting, weight
loss, and electrolyte disturbance.
Mild cases are treated with
dietary changes, rest, and 
antacids. More severe
HYPEREMESI cases often require a stay in the
S hospital so that the mother can
receive fluid and nutrition
GRAVIDARUM through an intravenous line (IV).
DO NOT take any medications to
solve this problem without first
consulting your health care
provider.
  Also called “pernicious or
persistent vomiting”
 Nausea and vomiting of
pregnancy prolonged past
week 16 of pregnancy or that
HYPEREMESI is so severe that dehydration,
S ketonuria, and significant
weight loss occur within the
GRAVIDARUM first 12 weeks of pregnancy
(Kuru et al.,2011).
 It occurs at an incidence of 2%
in pregnant women.
 With Hyperemesis Gravidarum,
weight loss can be severe
because with so much nausea
and vomiting, a woman cannot
maintain her usual nutrition.
Urine may test positive for
ketones, evidence the woman’s
body is breaking down stored
fat and protein for cell growth.
  An elevated hematocrit
concentration may be detected
at a monthly prenatal visit
because the inability to retain
fluid has resulted in
hemoconcentration (which is
HYPEREMESI dangerous because it can lead
to thromboembolism).
S  In contrast, concentrations of
GRAVIDARUM sodium, potassium and
chloride may be reduced
because of a woman’s low
intake; hypokalemic alkalosis
may develop from loss of
hydrochloric acid from
  In some women, ataxia and
confusion, caused by
deficiency of Vitamin B1
(thiamine), develops. If left
untreated, a woman with
hyperemesis may become so
HYPEREMESI dehydrated, she can no longer
provide a fetus with essential
S nutrients for growth, and
GRAVIDARUM intrauterine growth restriction
or preterm birth may result
(McCarthy, 2012).
Why does it happen?

The majority of pregnant women experience

some type of morning sickness (70 – 80%).
Recent studies show that at least 60,000
cases of extreme morning sickness
called hyperemesis gravidarum (HG) are
reported by those who treated in a hospital but
the numbers are expected to be much higher
than this since many women are treated at
home or by outpatient care with their health
care provider.
Why does it
happen?
It is believed that this severe nausea is caused by a rise
in hormone levels; however, the absolute cause is still
unknown. The symptoms of HG usually appear between
4-6 weeks of pregnancy and may peak between 9-13
weeks. Most women receive some relief between weeks
14-20, although up to 20% of women may require care
for hyperemesis throughout the rest of their pregnancy.
There is no known prevention of Hyperemesis gravidarum
but you can take comfort in knowing that there are ways
to manage it.
Why does it happen?

The cause is unknown, but women with the

disorder may have increased thyroid function
because of the thyroid-stimulating properties of
human chorionic gonadotropin. Some studies
reveal it is associated with Helicobacter pylori,
the same bacteria that causes peptic ulcer
(Mansour & Nashaat,2011).
Distinguishing between morning sickness and
hyperemesis gravidarum:
Hyperemesis
Morning Sickness Gravidarum

Nausea sometimes accompanied Nausea accompanied by severe

by vomiting vomiting
Nausea that subsides at 12 weeks Nausea that does not subside
or soon after
Vomiting does not cause severe Vomiting that causes severe
dehydration dehydration
Vomiting that allows you to keep Vomiting that does not allow you to
some food down keep any food down
Signs and Symptoms
● Severe nausea and vomiting
● Food aversions
● Weight loss of 5% or more of pre-
pregnancy weight
● Decrease in urination
● Dehydration
● Headaches
● Confusion
Signs and Symptoms
● Fainting
● Jaundice
● Extreme fatigue
● Low blood pressure
● Rapid heart rate
● Loss of skin elasticity
● Secondary anxiety/depression
Assessment
● Always try to determine exactly how
much nausea and vomiting women
are having during pregnancy. Ask
each to describe the events of the
day before. How late into the day
did the nausea last? How many
times did she vomit and how much?
What was the total amount of food
she was able to eat?
Treatment &
Managemen
t
 Women with hyperemesis gravidarum may need to be hospitalized for 24 hours to
document and monitor their intake, output, and blood chemistries and to restore hydration.
All oral food and fluids are usually withheld for the first 24 hrs. Intravenous fluid (e.g.,
3,000 ml of Ringer’s lactate with added vitamin B1) may be administered to increase
hydration. An antiemetic, such as metoclopramide (Reglan, pregnancy class B), may be
prescribed to control vomiting. Throughout this period, carefully measure intake and
output, including the amount of vomitus, so the degree of hydration can best be evaluated.
If there is not vomiting after the first 24 hrs. of oral restriction, small amounts of clear
fluid can be started and the woman discharged home, usually with the referral for home
care. If she can continue to take clear fluid without vomiting, small quantities of dry toast,
crackers or cereal can be added every 2 or 3 hrs., after which the woman may gradually
advanced to a soft diet. If vomiting returns at any point, enteral or total parenteral
nutrition may be prescribed to ensure she receives adequate nutrition (Tan & Omar, 2012)
 In some cases, hyperemesis gravidarum is so severe that
hospitalization may be required.

0 Hospital treatment may include some or all of the following:

1 Intravenous fluids (IV) – to restore hydration, electrolytes, vitamins, and
nutrients

Tube feeding:
Nasogastric – restores nutrients through a tube passing through the nose
and into the stomach
Percutaneous endoscopic gastrostomy – restores nutrients through a
tube passing through the abdomen and into the stomach; requires a
surgical procedure
Medications – metoclopramide, antihistamines, and anti-reflux
medications*
Other treatments may include:

Bed Rest –This may provide comfort, but be cautious and aware of the

effects of muscle and weight loss due to too much bed rest.

Acupressure – The pressure point to reduce nausea is located at the

middle of the inner wrist, three-finger lengths away from the crease of the
wrist, and between the two tendons. Locate and press firmly, one wrist at a
time for three minutes. Sea bands also help with acupressure and can be
found at your local drug store.

Herbs – ginger or peppermint

Homeopathic remedies are a non-toxic system of medicines. Do not try to
self-medicate with homeopathic methods; have a doctor prescribe the
proper remedy and dose.
Hypnosis
* When it comes to medications, it is very
important that you weigh the risks and the
benefits. Some drugs may have adverse
effects on you or the development of your
baby. Discuss the risks and side effects of
each drug with your health care provider.
Thank you!!!
Thank you!!!
Thank you!!!
References:
● Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family; Adele Pillitteri,
PhD, RN, PNP; 7th Edition , 2014
● https://americanpregnancy.org/pregnancy-complicati
ons/hyperemesis-gravidarum
/
QUIZ : Identification
1. ___________ is also called “pernicious or persistent vomiting”.
2. An elevated hematocrit concentration may be detected at a monthly prenatal
visit because the inability to retain fluid has resulted in ___________.
3. to 7. Give at least 5 Signs and Symptoms of this condition.
8. Intravenous fluid ____________________ may be administered to increase
hydration.
9. An antiemetic, such as _______________ may be prescribed to control vomiting.
10. This may provide comfort, but be cautious and aware of the effects of muscle
and weight loss due to too much _____________.
 FACTORS TO
1-3 4-6 CONSIDER
7-9
MONTHS MONTHS MONTHS

Mercury is the Venus is the Neptune is the

closest planet to the second planet farthest planet from
Sun from the Sun the Sun
CLINICAL
TRIAL
PRECLI PHASE PHASE PHASE
NICAL
Lab studies 1
Human 2
Expanded 3 &
Efficacy
safety safety safety

Tens Hundreds Thousand

s

Low dose Medium Medium

dose with dose,
placebos randomized
01 COMP
ANY
You could enter a
subtitle here if you
need it
AWESO
ME
WORDS
 CLINICAL TIMELINE
CONCLUSIO
NS
PRECLIN Neptune is the
farthest planet
ICAL
Earth is the from the Sun
planet we live on 05
04
03 RESUL
01 02 TS
Mercury is the
EXPERIMEN
closest planet to
TATION the Sun
RESEA Despite being red,
Mars is actually a
RCH
Venus has a cold place
beautiful name,
but it’s quite hot
PHASE 1
DURATION AND
SAMPLE
DOSAGE
● 100-150 people 0.1 ml 0.5 ml 0.9 ml
● 20% healthy
● 25-30 years
1 5 9
Month Months Months
CONTROL
90 Effectiven
ess
GROUPS

% Group A

0.9 Ideal dose

Group B

ml
A PICTURE
ALWAYS
REINFORCE
S THE
Images reveal large
CONCEPT
amounts of data, so
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 TENDENCY
Mercury is the closest
planet to the Sun and the
smallest one in our Solar
System—it’s only a bit
larger than our Moon

MERC
URY
MARS

VENUS

If you want to modify this graph, click on it, follow the link, change the data and
replace it here
 RESULTS ANALYSIS
NEPTUNE SATURN

60%
Mercury

10 90 35
30% 80%
Mars
%
Venus
Mercu %
Mars %
Venu
ry s
SUCCESS RATE

PATIENT

90% S
CURED

WITHOUT
70% SECONDARY
EFFECTS
 CONCLUSIONS

JUPITER
It’s the biggest
planet in our
Solar System

01 03
02
MERCURY VENUS
Mercury is the NEPTUNE Venus has a beautiful
closest planet to name, but it’s
Neptune is the
the Sun terribly hot
farthest planet from
the Sun
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