MIDWIFERY II PRESENTATION
MUGABE JOSHUA
Hyperemesis gravidarum(HG)
Definition
Signs and symptoms
Investigations
Management
Complications
Definition
Excessive nausea and vomiting in the first half of pregnancy
not responding to simple measures and destabilizing
pregnancy or/and the mother’s life.
It is most common in the first three months of pregnancy,
molar or multiple pregnancy.
Signs and symptoms
Severe nausea and feeling faint and dizzy when
standing(postural hypotension)
Persistent vomiting which can lead to dehydration
Dehydration, fatigue, light-headedness. Morning sickness,
anxiety, hyper salivation, ketosis, weight loss(>5% of prepregnancy weight).
Diagnosis
 Period of amenorrhoea
 History of nausea and excessive vomiting not responding to
simple measures
The woman has difficulty in performing normal daily duties
 Weak, dehydrated, tachycardia
Differential Diagnosis
Malaria
 Urinary Tract Infection (Pyelonephritis and Cystitis)
 Gastrointestinal disorder
 Hepatitis
 Pancreatitis
Central nervous system disease
Investigations
 Blood for:
Haemogram
Urea and electrolytes
Malarial parasites
Urinalysis
 Ultrasound scan to confirm pregnancy and rule out molar or
multiple pregnancy
Management
Immediate Treatment
• Take history, review past records and examine the mother
• If the mother is dehydrated, start IV fluids (normal saline
alternating with 5% dextrose OR Ringer’s Lactate).
Treat with antiemetics:
• Metoclopramide (Plasil) IM (10 mg 8-hourly)
• OR Phenogan (promethazine hydrochloride) IM (12.5 mg 8-hourly
for 24 hours).
• OR Prochlorperazine (Buccastem, Stemetil) IM (12 mg once 12hourly)
Cont.
Note: If vomiting subsides, give antiemetics orally.
In addition to any of the above antiemetics, give Vitamin B
complex, 2ml in 500mls of Normal Saline or Ringer’s Lactate, single
dose
If condition doesn’t improve within 24 hours, consult or refer to
higher level facility.
• Use of ginger can help reduce hyperemesis.
• If patient improves, encourage oral and frequent fluid intake at least
three litres in 24 hours.
Counsel on the following
• Possible aggravating factors like if the pregnancy is not
wanted/planned, family problems and complications that may arise if
the condition continues
• Avoid nauseating drugs e.g. Metronidazole, Ferrous Sulphate,
(Iron), sweetened drinks, fatty foods
• Encourage the mother to eat dry foods like roasted cassava,
popcorns, hard corns which should be taken in the morning before
any meal
• Brush the teeth at night at least one hour after a meal Note: Avoid
brushing the teeth in the morning or immediately after meals
• Mother should come out of bed very slowly in the morning
Follow-up
• Review after 1 week. Then resume subsequent visits as per
antenatal schedule.
• Identify appropriate social support for the mother during the
course of treatment.
Note: Excessive vomiting can result to reduced levels of
vitamin B complex. Use of vitamin B complex prevents
Wernicke’s encephalopathies
COMPLICATIONS
Dehydration
Electrolyte imbalance
Weight loss
Preterm labor
Maternal morbidity such as micronutrient deficiency, GI bleeding
Low birth weight(LBW)
Preterm birth(PTB)
Small-for-gestational age(SGA)
Perinatal death
References
Essential Maternal and Newborn Clinical Care Guidelines for
Uganda
Uganda Clinical Guidelines 2020
https://bmcpregnancychildbirth.biomedcentral.co
https://www.ncbi.nlm.nih.gov
22 January, 2023