扬州大学：《妇产科学》课程教学课件（PPT讲稿）07 妊娠剧吐 Hyperemesis Gravidarum

PerniciousVomitingofPregnancyHyperemesis Gravidarum(HG)

Pernicious Vomiting of Pregnancy Hyperemesis Gravidarum (HG)

NamesPernicious vomiting of pregnancy Severe nausea and vomiting of pregnancy Severe morning sicknessPersistent vomiting of pregnancyHG (hyperemesis gravidarum)Uncontrollable vomiting during pregnancy

Names • Pernicious vomiting of pregnancy • Severe nausea and vomiting of pregnancy • Severe morning sickness • Persistent vomiting of pregnancy • HG (hyperemesis gravidarum) • Uncontrollable vomiting during pregnancy

. Nausea is the unpleasant, painless sensationthat one may potentially vomit.Vomiting is an organized, autonomicresponse that ultimately results in the forcefulexpulsion of gastric contents through themouth

• Nausea is the unpleasant, painless sensation that one may potentially vomit. • Vomiting is an organized, autonomic response that ultimately results in the forceful expulsion of gastric contents through the mouth

Protective MechanismNormal nausea and vomiting may be an evolutionary protectivemechanism.It may protect the pregnant woman and her embryo from harmfulsubstances in food such as pathogenic microorganisms in meatproducts and toxins in plants, with the effect being maximal duringembryogenesis, (the most vulnerable period of pregnancy). This is supported by studies showing that women who had nauseaand vomiting during, pregnancy were less likely to havemiscarriages and stillbirth

Protective Mechanism • Normal nausea and vomiting may be an evolutionary protective mechanism. • It may protect the pregnant woman and her embryo from harmful substances in food such as pathogenic microorganisms in meat products and toxins in plants, with the effect being maximal during embryogenesis, (the most vulnerable period of pregnancy). • This is supported by studies showing that women who had nausea and vomiting during pregnancy were less likely to have miscarriages and stillbirth

Incidence50% to 90 % of pregnant women report having some nausea intheir first trimester.More than 40 % report vomitingVomiting usually begins around the 5th to 6th week of pregnancy,peaking at 9 weeks, and usually resolves on its own by week 16_ 18;however, symptoms may continue until the third trimester in 15to 20% of gravida and until delivery in 5%.If vomiting persists beyond a few days postpartum, otheretiologies should be investigated. Severe, persistent vomiting is called hyperemesis gravidarum andoccurs approximately in 3.5 per 1000 pregnancies.Hyper means ‘over', Emesis means ‘vomiting' and Gravidarummeans“pregnancy

Incidence • 50% to 90 % of pregnant women report having some nausea in their first trimester. • More than 40 % report vomiting. • Vomiting usually begins around the 5th to 6th week of pregnancy, peaking at 9 weeks, and usually resolves on its own by week 16 – 18; • however, symptoms may continue until the third trimester in 15 to 20% of gravida and until delivery in 5%. • If vomiting persists beyond a few days postpartum, other etiologies should be investigated. • Severe, persistent vomiting is called hyperemesis gravidarum and occurs approximately in 3.5 per 1000 pregnancies. • Hyper means ‘ over ’ , Emesis means ‘vomiting’ and Gravidarum means ‘ pregnancy’

EpidemiologyItis more common in:PrimigravidaMultiple pregnancyHistory of previous hyperemesisMother or sister with HGThepresenceoftrophoblastic diseasePreviousintolerancetooral contraceptivesYoung maternal age under the age of 20Lowtomiddle socioeconomic classLowerlevelsofeducationCarrying a female fetusNo previous completed pregnanciesObesityHistoryof infertilityCorpus luteum in right ovaryNonsmokersWomenpronetotravel sicknessMedical complications of hyperthyroid disorders, psychiatric illness, gastrointestinaldisorders, pregestational diabetes, and asthmaItis less common withMaternal age older than 30 yearsMaternal smokingUnmarriedmothers

Epidemiology It is more common in: • Primigravida • Multiple pregnancy • History of previous hyperemesis • Mother or sister with HG • The presence of trophoblastic disease • Previous intolerance to oral contraceptives • Young maternal age under the age of 20 • Low to middle socioeconomic class • Lower levels of education • Carrying a female fetus • No previous completed pregnancies • Obesity • History of infertility • Corpus luteum in right ovary • Nonsmokers • Women prone to travel sickness • Medical complications of hyperthyroid disorders, psychiatric illness, gastrointestinal disorders, pregestational diabetes, and asthma It is less common with • Maternal age older than 30 years • Maternal smoking • Unmarried mothers

Degree of Nausea and VomitingDuring PregnancyINEARLYPREGNANCY-Relatedtopregnancy- Mild --- in evening or morning ---- mild emesis gravidarum- Moderate-with meals----moderateemesis gravidarum- Severe --- frequent more than 10 times / day-without affection of general condition of pregnancy---severeemesisgravidarum-with affection of general condition of pregnancy ----- HYPEREMESISGRAVIDARUM=hyperemsisgravidarumwithoutcomplications=hyperemsisgravidarumwith complications-Other causes of nausea and vomitingINLATEPREGNANCY-HYPEREMESISGRAVIDARUM-Other causes of nausea andvomiting

Degree of Nausea and Vomiting During Pregnancy IN EARLY PREGNANCY - Related to pregnancy – Mild - in evening or morning - mild emesis gravidarum – Moderate – with meals - moderate emesis gravidarum – Severe - frequent more than 10 times / day - without affection of general condition of pregnancy-severe emesis gravidarum - with affection of general condition of pregnancy - HYPEREMESIS GRAVIDARUM = hyperemsis gravidarum without complications = hyperemsis gravidarum with complications - Other causes of nausea and vomiting IN LATE PREGNANCY -HYPEREMESIS GRAVIDARUM - Other causes of nausea and vomiting

hyperemesis gravidarum without complicationswith affect on general condition of pregnant increase pulseover 100 + Decrease systolic blood pressure below 100 +increase temp above 38 degree + dehydration like dry tongue,sunken eyes +ketosishyperemesis gravidarum with complicationsEsophageal rupture or perforationPneumothorax and pneumomediastinumWernicke encephalopathy or blindnessHepatic diseaseSeizures, coma, or deathOthers complications include renal failure, pancreatitisdeep venous thrombosis, pulmonary embolism, central pontinemyelinolysis, rhabdomyolysis, Vitamin K deficiency andcoagulopathy, and splenic avulsion

hyperemesis gravidarum without complications • with affect on general condition of pregnant increase pulse over 100 + Decrease systolic blood pressure below 100 + increase temp above 38 degree + dehydration like dry tongue, sunken eyes + ketosis hyperemesis gravidarum with complications • Esophageal rupture or perforation • Pneumothorax and pneumomediastinum • Wernicke encephalopathy or blindness • Hepatic disease • Seizures, coma, or death • Others complications include renal failure, pancreatitis, deep venous thrombosis, pulmonary embolism, central pontine myelinolysis, rhabdomyolysis, Vitamin K deficiency and coagulopathy, and splenic avulsion

SeverityAssessment of severity by checking forketones is important as severity determinesmanagement

Severity Assessment of severity by checking for ketones is important as severity determines management

Emesis GravidarumHyperemesis GravidarumRareCommonConfined to mealsRepeated throughout daysevere and persistentDoes not affectgeneral conditionAffectsgeneral conditionweightloss,dehydration,nutritionaldeficiencies, electrolyte imbalance,pHimbalance (metabolic acidosis), and possibleliverdamageResolvesaround12weeksProgressive course even fatalunlesseffectivetreatmenteven withouttreatmentOften persists for the duration of pregnancyAlwaysrequireshospitalizationRarelyneedshospitalizationNeed oral fluidNeedenteralorarenteralfluid

Emesis Gravidarum Hyperemesis Gravidarum Common Rare Confined to meals Repeated throughout day severe and persistent Does not affect general condition Affects general condition weight loss, dehydration, nutritional deficiencies, electrolyte imbalance, pH imbalance (metabolic acidosis), and possible liver damage Resolves around12 weeks even without treatment Progressive course even fatal unless effective treatment Often persists for the duration of pregnancy Rarely needs hospitalization Always requires hospitalization Need oral fluid Need enteral or arenteral fluid