nausea and vomiting in pregnancy

Question 1

how many women are expose to have nes anad vominting and when ?

Answer 1

_about 50-80% of wmen have nausea while 25% have vomiting

_it happen beteen the 4th - 6th week of pregnancy
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Question 2

whatre the types of nausea and vomiting in pregnency ?

Answer 2

1- physilogical it called moring sickness

2- pathological its calle dthe hyperemisis gravidium

Question 3

whatre the feature of the morning sickness ?

Answer 3

_its normal thing happen to pregnent women
nausea happpen to 50-80% and only 25% have vomiting
- it happen in the 4th-6th week بالشهر الاول

• it the nausea is mild may or not associated with the vomiting but dont interfer with the daily life
• no treatment just self limiting
• may be mange to prevent the hyperemisis gravidium

Question 4

whatre the features of hyperemisis ?

Answer 4

_pathological vomiting in the early pregnency need to addmit the hospital

_ its happen only for 0.5 -2%
_pt will have repeat vomiting and can’t eat or drink and interfer with the daly life
- pt with dehydration and ketosis and wieght loss 5% of body weight
-it aggrivated by hungery and iron intake or smell
- its associated with nutrintaional disorder B 1/6/12

Question 5

whatre the causes of the hyperemisis ?

Answer 5

1- increase in beta HCG in multiple pregnency or hyditiform mole or may be the sensevity increse to the HCG in primi

2- incease the estrogen and progestron hormone
3- increse in the cytokine as
necrosis alpha feto protein and interlukine 6
4- increase in the thyroid hormone
5-Gastritis because of H pylori
6- decrese in vit K, Thaimine (vitamin B), zinc
7- psychology

Question 6

whatre type od investigation which done with pt with hyperemisis ?

Answer 6

1- non specific investigation
as
-complete blood count
- WBC (infection. It may also be a sign of physical or emotional stress. People with particular blood cancers)

• blood urea (Urea is made in the liver and passed out of your body in the urine. A BUN test is done to see how well your kidneys are working.)
• general urine exam (to see the gluocose level and ketone )
• liver function test if there is heptitis
• thyroid test TSH for thyoditis

2- specfic investigation for underlying cause

Question 7

whatre the differntail dignosis of the hyperemisis ?

Answer 7

1- either pt have infection as UTI / mangitis / heptitis / GE
Gastroesophageal (GE) Reflux

2- main cause is thyroditis or DM we look for urine test for sugar and ketone

3- she has GIT disoder as gastitis send for Hpylori test or appencitis , cholcyctis and fatty liver bowel obstruction

4- or ask the pt if she take druga that make these sptomas as antibiotic or iron thepy

Question 8

what re the mangmanets?

Answer 8

1- rehydration oral or parentarl with nutritional support
2- antiemisis not only by drugs but by thr diet and life style recomindation as emotional support ans ginger 1g per day

3- enternal tube in severe cases
4- termination of pregnencywha
diet advice
————————

1- dink only small amount 
2- fluid are better than water 
3- have sold food in the early moring to avoid empty stomach 
4- small amount of food 
5- avoid fatty and spicy food 

 life style advice ---------------------------------- 1- if the smell of the hot meal make you ill have cold meal and dont cook 2- lie down  3- avoid stress 4- eat when U R hungery and when U R  feel your best 

drug for mangment  ---------------------------------------- 1- give vit B6 pyridoxine and antihistamine (doxylamine ) we can give the pyrodoxine alone in a dose 25mg /8h  or if it give with doxylamine dose is 10 for vit and 25 for the doxylamine 

2- metocloprimide (dopamine antagonist ) inhibit gastric mobility

3- corticosteroid (predisolone ) use in sever cases because is teratogenic

Question 9

whatre the indication of tremination of the pregnency ?

Answer 9

1-hepatic fatty degeneration

2- hepato renal encephalopathy