Hyper Emesis Gravidarum

Excessive vomiting in pregnancy is a rare condition found in approximately 1 in 500 pregnancies. Nausea and vomiting exists and dehydration and keto-acidosis escalate with the result that the serum electrolyte balance is disrupted. Cause:- It is unclear but it is known to be associated with:

· Multiple pregnancy

· Hydatidiform mole

· A history of unsuccessful pregnancies

A proportion of women who experience this condition will have a recurrence in subsequent pregnancies.

Assessing the mother’s condition

· Ask the woman whether normal diet has been resumed and tolerated.

· Identify any events producing stress or anxiety, as these may exacerbate any vomiting.

· Ascertain whether the nausea and vomiting are accompanied by pain; the location of any pain should be elicited.

· Dryness or inelasticity of the skin

· The mother’s weight will be less than expected for gestation.

· The pulse rate will be weak and rapid and the blood pressure will be low.

· The urine will smell of acetone, be scant and dark in colour

· It is usual for a mother suffering from hyper emesis gravidarum to be admitted to hospital.

Treatment

• Calm, reassurance and giving sensitive information should be accompanied by competent attention to physical needs.

• The potassium and sodium levels will be corrected by intravenous therapy.

• The infusion will be continued until hydration and electrolyte return to normal.

• Vitamin B12 and C, folic acid and iron will be required to correct the anaemia.

• Observe the blood pressure, pulse rate and temperature at least 4-hourly.

• Measure the intake and out put of fluids, including vomitus,

Once vomiting has ceased for a period of 24 hours oral fluid may be commenced and if these are tolerated a light diet may follow. Normal food is gradually introduced and intravenous therapy discontinued.