hyperemesis

• Hyperemesis gravidarum


  A condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance
• Hyperemesis gravidarum


  • Women with previous history are likely to experience
  • Sensitivity to normal level of hCG and other hormones
  • Trophoblast disease
  • Multiple pregnancy
  • Family history
  • Psychological factor (being a first-time mother)
• hCG


  A hormone created during pregnancy by the placenta. Your body produces a large amount of this hormone at a rapid rate early in pregnancy. hCG levels typically double every 48 to 72 hours. These levels can continue to rise 10-12 weeks of your pregnancy then lower
• Causes of hyperemesis gravidarum

  • Pernicious vomiting (FATAL)
  • Poor appetite with distract loss of weight (>25%)
  • Dehydration with electrolyte imbalance
  • Acidosis r/t starvation
  • Decrease urine output
  • Rapid pulse and low blood pressure
  • Hemoconcerntration with increase BUN and fall in Na, Cl, K
  • Jaundice in severe case
• Severity of hyperemesis gravidarum


  • Mild: loss of weight without dehydration
  • Moderate: dehydration and change in circulatory
  • Severe: biochemical changes with complications
• Diagnosis of hyperemesis gravidarum


  1. Complete history

  2. Electrolyte role out test

  3. USG: to screen the trophoblast and number of fetus inside
• Complications/effects of hyperemesis gravidarum

  • Circulatory failure
  • Jaundice
  • Retinal hemorrhage
  • Wernicke's encephalopathy and Korsakoff's syndrome (loss of memory and loss of memory)
  • Renal insufficiency
  • Polyneuritis/Guillain-Barre syndrome
  • Delirium, coma and even to death
• Guillain-Barre syndrome


  A rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells in your peripheral nervous system. This leads to weakness, numbness, and tingling. It can eventually cause paralysis
• Management of hyperemesis gravidarum


  1. Natural method: Vitamin supplements or ginger, frequent meals and dry foods such as crackers, drink plenty of fluids to stay hydrated, adequate rest and diet

  2. In severe case: Hospitalization is must and NPO, Correction of hypovolemia and electrolyte imbalance by intravenous, anti-nausea drugs are promethazine and meclizine by IM/IV, Monitor weight, Small and frequent palatable meal as she improves

  3. Termination is recommended in severe case with jaundice, persistent albumin urea, and polyneuritis

  4. Any medication have affect on pregnancy thus, advise patient meet her doctor before taking any drug
• Causes of vaginal bleeding in early and during pregnancy

  • Abortion
  • Ectopic pregnancy
  • Hydatidiform mole
  • Hyperemesis gravidarum
  • Rh isoimmnization and ABO incompatibility
  • Retroversion gravid
  • Choriocarcinoma
• Retroversion uterus


  When the uterus long axis is directed backward, which slightly increase the risk early bleeding and abortion. Due to increase in compression of uterine vessels resulting decrease in blood flow to the uterus (decidua). Uterus growing within the pelvic cavity below sacral promontory
• During 1st trimester retroversion uterus is considered normal (11%) as it gets back to its axis later term as uterus rise out of the pelvic into the abdominal cavity</b>
• Incarcerated RGU


  If the return of the uterus fails, then called as incarcerated RGU. It may complicate with rupture of membrane and also rapture of other organs leading to bleed
• Causes of retroversion uterus

  • Congenital abnormalities of uterus and pelvis: Bicornated or septum uterus
  • Medical condition related to pelvic or uterus: Tumor, fibroid, pelvic adhesion, endometrosis
• Manifestations of retroversion uterus

  • Abdominal discomfort
  • Feeling of pelvic fullness
  • Lower back pain
  • Urine retention and stasis (infection)
  • Rectal pressure and constipation
  • Difficult to locate FHS
• Distinction between uterus positions

  • More common: Anteverted (tipped forward)
  • Less common: Retroverted (tipped backwards)
  • Anteflexed (the fundus is pointing forward relative to the cervix, anterior of uterus is concave)
  • Retroflexed (the fundus is pointing backwards, anterior of uterus is convex)
• Finding and management of retroversion uterus


  1. USG

  2. On abd. palpation - distended bladder

  3. Fetal heart sound will be difficult to hear

  4. Urgency and frequency of voiding

  5. Catherrization to reduce retention and also it helps to regain uterus back to axis

  6. Sleep on stomach for a day or two

  7. Manual or surgical measures