GESTOSIS

Dr. Johanes C. Mose,dr, SpOG (K)

Department of Obstetrics & Gynecology
Faculty of Medicine, Padjadjaran University
Bandung

Gestosis

Gestatio = Pregnancy
No Toxin
Early gestosis : hyperemesis
gravidarum

Late gestosis : Hypertensive disorders

during pregnancy
(EPH gestosis)

Hyperemesis gravidarum

50 - 70% normal pregnancy < 16 weeks

66% normal pregnancy nausea
Insidence: 4 : 1000 pregnancy
Definition: vomiting pernicious to
produce :
weight loss
dehydration
acidosis from starvation
alkoholis from loss of HCl in vomitus
hypokalemia

Etiology

?
Appears to be related to :
High/rapidly increse levels of hCG or
estrogens
Social and psychological factors
GIT disturbances in DM patients
Chemoreceptor trigger zone disturbances
Hormonal imbalance
Disturbance in liver metabolism

Diagnosis

Clinical symptoms :

Severe vomiting
Dry mouth
Thristy
Foetor ex ore
Weight loss
Increase temeperature
Icterus
Cerebral disorders

Laboratory :

Hypokalemia

Acidosis

Urine analysis : protein, aceton bodies,

urobilinogen, phophyrin, cylindric cast

Starting from 5-6 weeks gestation and

slowly recovers spontaneous around 12
weeks gestation

In severe cases, rule - out

Gastritis
Cholecystitis
Pancreatitis
Peptic ulsers
Pyelonephritis
Fatty liver

Prognosis : good

Acetonuria disappear
Lactic aciduria disappear
Increase weight

Indication for hospitalization

Severe vomiting for everything per

oral

Weight loss > 10% normal weight

Dehydration

Acetonuria

Treatment
Mild cases :

Small portion food

Low fat
Multi vitamins
Antiemetic

Severe cases :

NPO = nothing per oral

Rehydration
Antiemetic

promethazine
prochlorperazine
chlorpromizine
droperidol - diphenhydramine
metoclopramide

Multi vitamins

Indications for termination

Icterus
Delirium and coma
Pulse rate > 130/m
Temperature > 380 C
Retinal bleeding
Uremia , proteinuria, cylindric cast