1
fourth stage
Obstetrics
Lec-2
Dr.Ahmed Jasim
17/11/2015
VOMITING IN PREGNANCY
• Vomiting is a common in normal pregnancy
• 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 .
2
• 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. deficiency
Aetology :
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 necrosis
PRESENTATION
1. Pat. can't retain food or fluid
2. wt. loss due to loss of body fluid& burning of fat
3. hamoconcentration & unstable acid –base balance
MANAGEMENT
1. Exclude UTI, intest. Obstruction ,infective hepatitis ,cerebral tumor , hiatus hernia
&G.B disease
2. Admission to hospital .
3. I.V. fluid +vit.Supplementation
4. Antiemitic
3
5. sedation small dose
6. Blood chemistry twice daily
Sign of response to RX
• cessation of vomiting
• normal urinary output
• wt. gain
• Oral feeding is begun as soon as possible
• Psychotherapy must consider