VOMITING IN PREGNANCY
MORING SICKNESS Dr. AHMED JASIM MBChB-DOG-FICOGVomiting is a common in normal preg. In morning 60 -80 % of nulliparous . 40 -60 % of multiparous . Nausea. Stop before 14 wk Not impair health & preg.
Etiology ; 1.Reflex stretch of peritoneum over ut. 2. Hormonal high level of HCG & Thyroid H. 3.Allergic response of maternal to fetal tissue. 4. psychological & emotional stress.
Mechanism; Induced through a chemo-sensitive trigger zone which stimulate the vomiting center.
MANAGEMENT; 1.exclusion of specific cause E.g UTI or reaction to iron tab. 2. Rest ; in morning stay in bed longer. 3.Frequent small nourish meal 4.Drug; antihistamine, antiemietic like meclozine, cycloizine,promethazine .
5.Give advice that the condition Is self limiting . Vomiting in late preg. Due to; 1.Gravid UT.PUSH THE stomach 2.esophageal reflux Rx by antiacid &postural advice
HYPEREMESIS GRAVIDARUM
Incidence; 1:700_1000 Def; Vomiting disturb the pat. Health. Lead to dehydration &hypovolemia with electrolyte Imbalance ,ketosis &vit. deficiencyAetology;
1.twin preg. 2.hydatidiform mole. 3.UTi. 4.psychological factor. 5. in sever condition wt. loss, tachycardia,oliguria&neurological disorder from vit B deficiency &jaundice from hepatic necrosisPRESENTATION
1.Pat. can't retain food or fluid 2.wt. loss due to loss of body fluid& burning of fat3.hamoconcentration & unstable acid –base balanceMANAGEMENT
1. Exclude UTI, intest. Obstruction ,infective hepatitis ,cerebral tumor , hiatus hernia &G.B disease
1.Admission to hospital . 2.I.V. fluid +vit.Supplementation 3. Antiemitic 4. sedation small dose 5.Blood chemistry twice daily
Sign of response to RX 1.cessation of vomiting 2.normal urinary output 3.wt. gain Oral feeding is begun as soon as possible Psychotherapy must consider