Case Reflection:

Hyperemesis Gravidarum
PRESENTED BY

HUSNI MUARIF
KOAS OBSGYN
14940 // FK UGM
 Patient
S A
◦ G1P0A0 20 th ◦ G1P0A0 H.16 minggu dengan Hiperemesis
◦ KU : Mual muntah terus menerus sejak 1 bulan, Gravidarum
memberat 3 hari yll, 5-6x/hari, tidak bisa makan

O P
◦ Compos mentis. IVFD RL :D5 1:1 30 tpm
◦ BP: 103/70 mmHg. HR: 87/min. Inj Metoclopramid 1A/8jam/iv
◦ T: 36.6*C RR: 18/min. As folat 1x1
◦ Abdomen: Membuncit sesuai umur kehamilan, Kalk 1x1
NT (-), BU (+).
◦ USG : Janin Tunggal DJJ (+), Gerak (+), CRL 10,5
Antasida syr 3xCI
cm  16 minggu 3 hari Diet TKTP
 Hyperemesis Gravidarum
Hyperemesis gravidarum (HG) or severe nausea/vomiting is generally defined as
intractable n/v ≥3 times a day with signs of dehydration (large ketonuria, high
urine specific gravity, or electrolyte imbalance) and weight loss of >3 kg or >5%
prepregnancy weight, having excluded other diagnoses.
Pregnancy Unique Quantification of Emesis and Nausea (PUQE) scoring index is
used to assess the severity.

Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014). Williams
obstetrics (24th edition.). New York: McGraw-Hill Education
Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
Second Edition.Series In Maternal Fetal Medicine. CRC Press,2011:72–80. (Series In Maternal Fetal Medicine;
 Incidence
Nausea and vomiting are common in early pregnancy; approximately 50%–80% will experience
nausea and 50% vomiting. HG affects only 0,3-1% of pregnancies.
60% resolve by the end of the first trimester, and 91% have complete resolution by 20 weeks
Daughters born to mothers with HG have a three times higher risk of future development
(Genetics)
Hospitalization rate was 0,5-0,8% of all HG cases. 20% of thos hospitalized in previous pregnancy
will again require hospitalization.

Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014). Williams
obstetrics (24th edition.). New York: McGraw-Hill Education
Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
Second Edition.Series In Maternal Fetal Medicine. CRC Press,2011:72–80. (Series In Maternal Fetal Medicine;
 Etiology
Decreased GI motility
Multifactorial Hormones
CTZ more sensitive
Vestibulo-occular reflex pathway
hCG
H. Pylori
Psychologic
Protection from teratogenic exposure
Genetic
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014). Williams
obstetrics (24th edition.). New York: McGraw-Hill Education
Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Complications
Maternal Fetal

Psychologycal morbidity Growth restriction

Wernicke’s encephalopathy Low Birth Weight, SGA

Peripheral neuropathy Gestational hypertension

Acute kidney Injury Preterm delivery

Mallory-Weiss Tear

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Workup
Labs
History Physical Exam
(serum, Urine)

Radiologic

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
 Management

Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal Evidence Based Guidelines,
Thank
You
Bibliography
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . .
Sheffield, J. S. (2014). Williams obstetrics (24th edition.). New York: McGraw-Hill Education
Mella M (2011). Nausea/vomiting of pregnancy and hyperemesis gravidarum. In: Maternal-Fetal
Evidence Based Guidelines, Second Edition.Series In Maternal Fetal Medicine. CRC
Press,2011:72–80. (Series In Maternal Fetal Medicine; https://doi.org/10.3109/9781841848235-
10).