Hyperemesis Gravidarum

Hyperemesis Gravidarum

Briony, Danielle, Eleanor, Jessica & Victoria

Nausea & Vomiting

What is the

midwifes role?

What is the potentioal impact on the fetus?

Life threatening in severe cases to mother and baby.

.

Physical:

Prolonged stress, malnutrition

and dehydration can put

child at risk of chronic illness later in life eg: diabetes and heart

disease,other potential complications; early delivery, congenital heart disease,

skin abnormalities, low birth weight, shorter length, hip dysplasia, undescended testes, large for age, neurodevelopmental dequelae, neural tube defects, central nervous system malformations, skeletal malformations, perinatal death, testicular cancer, behavioural/emotional problem (HER Foundation, 2013)

Insulin: Due to the reduced intake of energy the body receives less insulin and insulin growth hormone -1. Insulin facilitates the diversion of nutrients for example glucose from maternal cells to the placenta and fetus in early pregnancy (Huxley, 2000).

Prematurity, SGA, 5 min Apgar <7 (Sonkusare)

Mild - moderate - decreased risk of miscarriage, stillbirth and preterm delivery (Welsh, 2005)

Severe - fetal growth restriction and death may be a

consequence (Turner, 2007)

Psychological:

Affect on mother-infant relationship and attachment in the postnatal period.

Stronger interconnection between prefrontal cortex and orbitofrontal area of the brain.

If the baby is exposed to a negative environment, can have sustained effts and lifelong consequences

Common symptoms of pregnancy

Occurs in up to 90% of pregnancies

Nausea - feeling of impending vomiting

Vomiting - retching and expulsion

(Pleuvry, 2006)

Mild to moderate (Nausea & Vomiting) -

Midwife to explain 'in most cases, condition will improve spontaneously with a

good pregnancy outcome'.

Medication not usually required, but to advise rest as tiredness and stress can exacerbate vomiting. Frequent small light meals, with low fat, not spicy or strong smelling. Milky drink at bedtime. Dry toast or biscuit before rising. Carbonated drinks; soda or non alcoholic dry ginger ale have been reported to elevate symptoms.

Complimentary therapy; vitamin B supplement, ginger, accupuncture, accupressure (Jewell & Young, 2003)

*Midwife may not use complimentary therapy for a woman unless

qualified (NMC, 2008)

HYPEREMESIS - Admission in to hospital, a single room if possible to avoid disturbance, urinalysis, medication, blood test (assess renal and liver

functions). USS to eliminate hydatidiform mole & multiple pregnancy.

Frequent record of womans weight, temp, pulse, BP & resps.

Fetal HR auscultated (depending on gestation) to monitor fetal

well being. IV fluids & fluid balance chart.

(McDonald & Magill-Cuerden, 2011)

Empathetic support is paramount, extended to the partner

and family, can place strain on relationships and

disrupt work patterns.

Hyperemesis Gravidarum

Alison is expecting her first baby, at 9 weeks gestation she is admitted yto the antenatal ward with a history of severe hyperemesis. She is unable to tolerate any food or fluid and has lost 8lbs in weight in the last 10 days.

On admission to the wardshe is very anxious, crying and carrying a bowl which contains bile stained fluid.

Her vital signs are:

BP: 100/60

P: 120

Temperature: 36.5 c

Her mucous membranes are very dry, her lips are very dry, cracked and sore.

Her breath smells strongly of pear drops.

MDT?

• Midwife
• Health Care Assistant
• Obstetrician
• Ultrasound Department

Pathological condition:

Unremitting, severe vomiting in pregnancy.

Causes severe dehydration.

Diagnosed upon presence of one or more of:

Hospital attendance due to symptoms and need for IV therapy.

Weight loss of >4kg or >5% since conception, associated with persistent vomiting.

(King Edward Memorial Hospital, 2014)

Lack of response to anti-emetics or other medications.

0.3-2.0% of pregnancies.

More common in : younger women, non smokers and

non caucasion (Ismail & Kenny, 2007)

LEading cause of hospital admissions in pregnancy

(Cedergrne et al, 2008)

What is the plan of care for Alison?

Multi Disciplinary Team?

SBAR?

Medicines Management?

Medicines Management

Cyclizine (antihistamine)

• Use: prevention, treatment of nausea and vomiting.
• Dosage: IM or IV, 50mg t.d.s
• Contraindications: hypersensitivity, cardiac disease.
• Side-effects: hypotension, drowsiness, blurred vision, urinary retention, constipation.
• Pharmacodynamic properties: Histamine H1 receptor antaonist- exact mechanism unknown, thought to act to increase oesophageal sphincter tone.

Phenothiazines e.g. chlorpromazine

Dopamine antagonsit e.g. metoclopramide

ondansetrone- potent anti-emetic. Usually given after 12/40.

(BNF, 2014)

SBAR?

• Situation: Alison, room 10, 9/40, admitted with hyperemesis, lost 8lbs in 10 days, BP:100/60, P:120, Temp:36.5.
• Background: G1 P0, Hyperemesis.
• Assessment: Urinalysis, MSU, LFT's, FBC, TFT's Ultrasound.
• Recommendation: Telephone obstetrician for perscription.