Hyperemesis Gravidarum
Nausea and vomiting is a natural phenomenon and is often caught in the first trimester of pregnancy. Nausea usually occurs in the morning, but can also occur at any time and at night. These symptoms occur approximately 6 weeks after the first day of the last menstrual period and lasts for approximately 10 weeks.
Nausea and vomiting occurred in 60% -80% primigravida, and 40% - 60% multi gravida. One in every 1000 pregnancies, these symptoms become more severe. The feeling of nausea is caused by increased levels of the hormone estrogen and HCG in serum. Physiological Effect of hormone increase is unclear, probably because the central nervous system or the reduced gastric emptying. In general, women can adjust to this situation, though the symptoms of severe nausea and vomiting that can last up to 4 months. Daily work was interrupted, and the general state of being bad. This condition is called hyperemesis gravidarum. Complaints of symptoms and physiological changes determine the severity of the disease.
Definition of Hyperemesis Gravidarum
Hyperemesis gravidarum is vomiting that occurs until 20 weeks gestation, are so great that all of what is eaten and drunk vomited thus affecting the general condition and daily work, weight loss, dehydration, there is acetone in the urine, not because of diseases such as appendicitis, pyelitis and so on.
Etiology of Hyperemesis Gravidarum
The cause of hyperemesis gravidarum is not known with certainty. Anatomic changes in the brain, heart, liver and nervous system caused by a deficiency of vitamins and other substances as a result of inanity.
Several predisposing factors and other factors were found:
Pathophysiology of Hyperemesis Gravidarum
Some claimed that, feeling of nausea is a result of increased estrogen levels, therefore these complaints occur in the first trimester.
Psychological Influence of estrogen is not clear, perhaps derived from the central nervous system or due to reduced gastric emptying. Adjustment occurs in most pregnant women, nausea and vomiting though can take months.
Hyperemesis gravidarum is a complication of nausea and vomiting in early pregnancy, when there is persistent can lead to dehydration and electrolyte imbalance with hypochloremic alkalosis. Unclear why this phenomenon occurs only in a minority of women, but psychological factors are the main factors, in addition to hormonal factors. What is clear is that women before pregnancy is already suffering with symptoms of spastic stomach does not like to eat and nausea, emesis gravidarum will experience severe.
Hyperemesis gravidarum can lead to carbohydrate and fat reserves used up for energy purposes. Because of incomplete fat oxidation, ketosis occurs with the accumulation of acetone-acetic acid, hydroxy butyric acid and acetone in the blood. Disadvantages fluid intake and fluid loss due to vomiting cause dehydration, so the extracellular fluid and plasma is reduced. Sodium and Chloride drop in blood, urine Chloride likewise. In addition, dehydration causes hemoconcentration, so that blood flow to the tissues is reduced. This causes the amount of nutrients and oxygen to tissues and decreases the buried toxic metabolic substances. Potassium deficiency as a result of vomiting and increased excretion through the kidneys, increasing the frequency of vomiting more, can damage the liver and there was a vicious circle that is difficult to break.
Signs and Symptoms of Hyperemesis Gravidarum
Hyperemesis gravidarum, according to the severity of symptoms can be divided into three (3) levels, namely:
1. Level I:
Persistent vomiting that affects the general state of the patient, the mother feels weak, no appetite, weight loss and epigastric pain. Increased pulse about 100 times per minute, systolic blood pressure decreased, decreased skin turgor, tongue dry and sunken eyes.
2. Level II:
Patients seem more weak and apathetic, more reduced skin turgor, tongue dries and looks dirty, small and rapid pulse, temperature sometimes rises and slightly jaundice eye. Weight loss and sunken eyes, low blood pressure, hemoconcentration, oliguric and constipation.
Acetone can be smelled in the air breathing, because it has a distinctive aroma and can also be found in urine.
3. Level III:
General condition is more severe, stop vomiting, decreased consciousness and somnolence to coma, small and rapid pulse, increased body temperature and blood pressure decreases. Fatal complications can occur in the nervous system known as encephalopathy Wemicke, with symptoms: nistagtnus and diplopia. This situation is due to the very lack of nutrients, including vitamin B complex. The onset of jaundice is a sign of heart trouble.
Management of Hyperemesis Gravidarum
Prevention of Hyperemesis gravidarum should be carried out by way of the application of pregnancy and childbirth as a physiological process, providing confidence that the nausea and sometimes vomiting are symptoms that physiological early pregnancy and will disappear after 4 months of pregnancy, suggesting me to change daily meals with small amounts of food but more often. Time to wake up early do not immediately get out of bed, but it is recommended to eat dry bread or biscuits with tea.
The food is greasy and smelling of fat should be avoided. Food and drinks should be served hot or very cold.
Nausea and vomiting is a natural phenomenon and is often caught in the first trimester of pregnancy. Nausea usually occurs in the morning, but can also occur at any time and at night. These symptoms occur approximately 6 weeks after the first day of the last menstrual period and lasts for approximately 10 weeks.
Nausea and vomiting occurred in 60% -80% primigravida, and 40% - 60% multi gravida. One in every 1000 pregnancies, these symptoms become more severe. The feeling of nausea is caused by increased levels of the hormone estrogen and HCG in serum. Physiological Effect of hormone increase is unclear, probably because the central nervous system or the reduced gastric emptying. In general, women can adjust to this situation, though the symptoms of severe nausea and vomiting that can last up to 4 months. Daily work was interrupted, and the general state of being bad. This condition is called hyperemesis gravidarum. Complaints of symptoms and physiological changes determine the severity of the disease.
Definition of Hyperemesis Gravidarum
Hyperemesis gravidarum is vomiting that occurs until 20 weeks gestation, are so great that all of what is eaten and drunk vomited thus affecting the general condition and daily work, weight loss, dehydration, there is acetone in the urine, not because of diseases such as appendicitis, pyelitis and so on.
Etiology of Hyperemesis Gravidarum
The cause of hyperemesis gravidarum is not known with certainty. Anatomic changes in the brain, heart, liver and nervous system caused by a deficiency of vitamins and other substances as a result of inanity.
Several predisposing factors and other factors were found:
- Predisposing factor often cited is primigravida, hydatidiform mole and multiple pregnancy. High frequency in hydatidiform mole and multiple pregnancy suggests that hormonal factors play a role, because in both circumstances chorionic gonadotropin hormone is formed in excess.
- The entry of chorionic villi into the maternal circulation and metabolic changes due to pregnancy and the resistance decreases maternal tehadap this change is organic factors.
- Allergy. As one response from maternal tissue to fetus, also referred to as one of the organic factor.
- Psychological factors play an important role in this disease, although the relationship with the occurrence of hyperemesis gravidarum is not known with certainty. Households cracking, loss of job, fear of pregnancy and childbirth, fear of responsibility as a mother, can cause mental conflict that can aggravate nausea and vomiting as an unconscious expression of the reluctance to become pregnant or as an escape because of hardship. Not infrequently to give a new atmosphere has been able to help reduce the frequency of vomiting clients.
Pathophysiology of Hyperemesis Gravidarum
Some claimed that, feeling of nausea is a result of increased estrogen levels, therefore these complaints occur in the first trimester.
Psychological Influence of estrogen is not clear, perhaps derived from the central nervous system or due to reduced gastric emptying. Adjustment occurs in most pregnant women, nausea and vomiting though can take months.
Hyperemesis gravidarum is a complication of nausea and vomiting in early pregnancy, when there is persistent can lead to dehydration and electrolyte imbalance with hypochloremic alkalosis. Unclear why this phenomenon occurs only in a minority of women, but psychological factors are the main factors, in addition to hormonal factors. What is clear is that women before pregnancy is already suffering with symptoms of spastic stomach does not like to eat and nausea, emesis gravidarum will experience severe.
Hyperemesis gravidarum can lead to carbohydrate and fat reserves used up for energy purposes. Because of incomplete fat oxidation, ketosis occurs with the accumulation of acetone-acetic acid, hydroxy butyric acid and acetone in the blood. Disadvantages fluid intake and fluid loss due to vomiting cause dehydration, so the extracellular fluid and plasma is reduced. Sodium and Chloride drop in blood, urine Chloride likewise. In addition, dehydration causes hemoconcentration, so that blood flow to the tissues is reduced. This causes the amount of nutrients and oxygen to tissues and decreases the buried toxic metabolic substances. Potassium deficiency as a result of vomiting and increased excretion through the kidneys, increasing the frequency of vomiting more, can damage the liver and there was a vicious circle that is difficult to break.
Signs and Symptoms of Hyperemesis Gravidarum
Hyperemesis gravidarum, according to the severity of symptoms can be divided into three (3) levels, namely:
1. Level I:
Persistent vomiting that affects the general state of the patient, the mother feels weak, no appetite, weight loss and epigastric pain. Increased pulse about 100 times per minute, systolic blood pressure decreased, decreased skin turgor, tongue dry and sunken eyes.
2. Level II:
Patients seem more weak and apathetic, more reduced skin turgor, tongue dries and looks dirty, small and rapid pulse, temperature sometimes rises and slightly jaundice eye. Weight loss and sunken eyes, low blood pressure, hemoconcentration, oliguric and constipation.
Acetone can be smelled in the air breathing, because it has a distinctive aroma and can also be found in urine.
3. Level III:
General condition is more severe, stop vomiting, decreased consciousness and somnolence to coma, small and rapid pulse, increased body temperature and blood pressure decreases. Fatal complications can occur in the nervous system known as encephalopathy Wemicke, with symptoms: nistagtnus and diplopia. This situation is due to the very lack of nutrients, including vitamin B complex. The onset of jaundice is a sign of heart trouble.
Management of Hyperemesis Gravidarum
Prevention of Hyperemesis gravidarum should be carried out by way of the application of pregnancy and childbirth as a physiological process, providing confidence that the nausea and sometimes vomiting are symptoms that physiological early pregnancy and will disappear after 4 months of pregnancy, suggesting me to change daily meals with small amounts of food but more often. Time to wake up early do not immediately get out of bed, but it is recommended to eat dry bread or biscuits with tea.
The food is greasy and smelling of fat should be avoided. Food and drinks should be served hot or very cold.
- Drugs
- Psychological Therapy
- Parenteral liquid
- Diet
