Hyperemesis gravidarum is excessive nausea and vomiting that disrupted their daily work and the general state of poor widened. Nausea and vomiting are the most common disorders in the first trimester of pregnancy, approximately at 6 weeks after the last menstrual period for 10 weeks. Approximately 60-80% and 40-60% primigravida multigravida experience nausea and vomiting, but these symptoms become more severe only in 1 in 1,000 pregnancies.
Etiology
Not yet known with certainty, but several factors have an influence, among others:
• predisposing factor, namely primigravida, hydatidiform mole, and multiple pregnancy.
• Factor organic, that is allergic, the entry of villi khorialis in circulation, metabolic changes due to pregnancy, and maternal resistance decreases.
• Factor psychology.
Pathophysiology
Pathophysiology
Feelings of nausea due to increased estrogen levels. Nausea and vomiting continuously can cause dehydration, hyponatremia, hipokloremia, decreased urine chloride, then there hemokonsentrasi reduced blood perfusion to the tissue and menebabkan tertimbunnya toxic substances. Use of reserve carbohydrates and fat cause fat oxidation is incomplete until there ketosis. Hypokalemia from vomiting and excretion of berlabihan further increase the frequency of vomiting and damage the liver. Esophageal and gastric mucus membrane to tear (Mallory-Weiss syndrome), causing gastrointestinal bleeding.
Clinical Manifestation
According to the severity of symptoms, hyperemesis gravidarum is divided into 3 levels, namely:
• Level I. continuous vomiting that affect the general situation, creates a feeling of weakness, no appetite, weight loss, and epigastric pain. Patient's pulse rate increased by about 100 times per minute, systolic blood pressure falls, decreased skin turgor, dry tongue, and sunken eyes.
• Level II. Patients appear weak and apathetic, dirty tongue, pulse small and quick, sometimes the temperature rises, and the eyes a little jaundice. Patient's weight down, resulting hypotension, hemokonsentrasi, oligouria, constipation and breath smelled of acetone.
• Level III. Awareness of patients decreased from somnolen to coma, vomiting stops, small and rapid pulse, temperature increases, and increasing blood pressure down.
Complication
Wernicke encephalopathy with symptoms nitragmus, diplopia and mental change, and heart pains with symptoms onset jaundice.
Diagnosis
From anamnesis obtained amenorrhea, pregnancy signs young, and vomiting constantly. On physical examination found the patient's condition is weak, apathetic to coma, pulse increased to 100 beats per minute, the temperature increases, blood pressure down, or there are other signs of dehydration. On examination of blood electrolytes sodium and chloride levels are found to fall. On examination of urine chloride levels drop and can be found ketones.
Differential Diagnosis
Vomiting due to gastritis, peptic ulcer, hepatitis, cholecystitis, pyelonephritis.
Prevention
The principle of prevention is the cure for hyperemesis not happen.
• Lighting that pregnancy and childbirth is a physiological process.
• Eat a little, but often. Give a snack such as biscuits, dry toast with hot tea when you wake up in the morning and before bed. Avoid greasy foods and smells. Food should be in a state of hot or very cold.
• regular defecation
Management
Management
When prevention does not succeed, it needs treatment, namely:
• The patient was isolated in a quiet and sunny room with good air exchange. Calories are given parenterally with 5% glucose in physiological fluids as much as 2-3 liters a day.
• diuresis always be controlled to maintain fluid balance.
• If during the 24 hours the patient is not vomiting and general condition gets better, try to give drinks and food gradually added.
• sedative is given phenobarbital.
• It is recommended that provision of additional vitamin B1 and B6.
• In more severe circumstances given antiemetics such as metoclopramide, disiklomin hydrochloride, or chlorpromazine.
• Provide psychological therapies to ensure patients the disease can be cured and eliminating fear and conflict that shape pregnancy hyperemesis.
If treatment is not successful, even more severe symptoms to arise jaundice, delirium, coma, tachycardia, anuria, and retinal bleeding, consider therapeutic abortion.
Prognosis
With good treatment, the prognosis is very satisfying. However, at a level that can cause serious maternal and fetal death.
