DISCOMFORT ABOUT NAUSEA AND VOMITING IN PREGNANT WOMEN

1.1 BackgroundNausea and vomiting is one of the earliest symptoms, most common and most cause of stress associated with pregnancy. However, obstetric physicians and general practitioners consider nausea and vomiting was merely a symptom fisioligis, and a problem that often makes them feel powerless to help overcome them. Nausea and vomiting often done because it is considered as a normal consequence of the early kahamilan without a negligible impact caused severe in women and their families.Women have emphasized that part of their satisfaction with care in early pregnancy is related to their perceptions of health professionals believe that the pain they suffered, not ignore or assume they are acting too much like pain, nausea is a symptom that is said by the patient (subjective) and if the symptoms are causing stress in women, he is entitled to be given the best possible way to overcome these symptoms. Due to underestimation rassa felt nausea and vomiting during pregnancy women proved to contribute in improving the emotional tension, psychological stress and undue delays in menumukan proper treatment, especially if the condition becomes pathological (Munch 2000).Experience nausea or vomiting in early pregnancy is common among expectant mothers. Symptoms are also called 'morning sickness' is not yet known for certain causes by experts, but often attributed to various factors such as the increase of various hormones and psychological influences.Medically this condition can be attributed to several things such as increase in the hormone Human Chorionic Gonodotropin (hCG) rapidly in early pregnancy as the development of the placenta. The increase in the hormones estrogen and progesterone in early pregnancy is also stated as one cause of nausea and feeling like vomiting and sense of taste and smell became more sensitive in early pregnancy.Vomiting during early pregnancy is sometimes frustrating experience that pregnant women indeed have been specially designed for the defense of the fetus, to protect the structure of genes, especially in early pregnancy is commonly referred to as the first trimester, because of this very vulnerable period to the toxin slightest.Vomiting is a traumatic experience for most of the people, but behind it we should be grateful peritiwa of this natural way of cleansing our bodies of poisons and toxins that will harm our body.
  

DEFINITIONS NAUSEA VOMITING

• understanding Nausea

Nausea is a feeling of consciously recognized on the occurrence of excitation is not realized at the center in the medulla oblongata muntag or in areas close to the vomiting center (Dayton, 1996)

• Definition of Vomiting

Vomiting is a complex series of movements to remove the intestinal contents of the intestinal tract when one of its parts become irritated or distension.

• Understanding Nausea Vomiting

Nausea (nausea) and vomiting (emisis gravidarum) are symptoms of a reasonable and often get in pregnancy trimester I. Nausea usually occurs in the morning, but it can also arise at any time and at night. Symptoms - these symptoms about 6 weeks of the first day of last menstrual period and lasts for 10 weeks (prawiroharjo, 2005)
Nausea or vomiting Morning sickness is actually a condition that is specifically designed as a protective mechanism for women who are pregnant seed that is not too often exposed to the toxin derived from the environment that could threaten the life of the fetus. So women become more sensitive to substances that will go into his body at the beginning of seed growth in the womb.
Morning sickness is the effect of an increase in pregnancy hormones, especially the hormone HCG (Human Chorionic Gonadotropin). This hormone increases dramatically at the beginning of pregnancy to the formation of the placenta (placenta) as a center for fetal nutrition during a cozy space called the mother's womb.
Emesis gravidarum or commonly known as nausea and vomiting is a common complaint presented to a young pregnancy. Nausea which when severe will cause vomiting, although there is a very disturbing feeling better after their (pregnant women) vomiting.
Clinical symptoms of emesis gravidarum is a headache, especially early morning, accompanied nausea vomiting in up to 4 months old krhamilan. Can be resolved with outpatient (polyclinic).

• CAUSE NAUSEA VOMITING

The cause of nausea is not known, but suspected due to psychological. Currently in the know that it is due to the turmoil in the normal state of body and partly due to changes in hormone levels in the blood during pregnancy to TM1. This situation could deteriorate in the presence of mental stress. Severity of nausea related to lifestyle expectant mothers. Less eating or poor diet, lack of sleep and stress can exacerbate the rest of nausea. 

FACTORS THAT CAUSE VOMITING FISIOPATOLOGI

1.Perubahan carbohydrate and fat metabolism
    These changes lead to hypoglycemia, especially when I wake up. The term that has been famous but not very accurately called the "morning sicknes", although it apparently does not cause hypoglycemia harmful outcomes when perinatal (Calfee et al, 1999). Really liked the taste of food more apparent in women experiencing vomiting more intense tang (Crystal et al, 1999), perhaps in an attempt to replace the nutrients that are less consumed during preconception or lost due to vomiting
2.Situasi corpus luteum
Position the right side korpue luteum results in high levels of steroid hormones in the hepatic portal system (Lindsay, 1997) but if this is true, all women will experience nausea and vomiting during kahamilan.
3.Factor genetic
Genetic incompatibility between the fetus and has been put forward as a factor (Lindsay, 1997) although this is more often cause spontaneous abortions, often accompanied by physiological symptoms kahamilan very little. Klebanoff and Mills (1986) investigated whether the vomiting is teratogenic but concluded that any increase in the incidence of fetal abnormalities are more likely to be caused by the medication itself than by vomiting. Genetic linkage can also be linked because there is an increased incidence of nausea and vomiting in women who have experienced symptoms tersebt mothers during their pregnancy.
4.Adaptasi gastrointestinal tract
Vomiting preceded by stimulation of the vomiting center in the medulla, which controls the smooth muscle in the stomach wall and skeletal muscle in the abdominal and respiratory system, and dsar chemoreceptor trigger zone in the fourth ventricle, near the vagus. Because of the chemoreceptor trigger zone outside the blood brain barrier, the chemoreceptor trigger zone to respond to chemical stimuli of drugs and toxins produced dl in certain pathological conditions; chemoreceptor trigger zone is also responsible for the occurrence of nausea or vomiting caused by motion. Stimulus in the chemoreceptor trigger zone delivered to the vomiting center which causes the muscles in the gastrointestinal tract and respiratory started vomiting.
Helicobacter 5.Infeksi pylorin
Jacoby and Porter (1999) consider the controversial relationship between hiperemisis gravidarum that continue to occur until the second trimester degan peptic ulcer caused by helicobacter pylori infection, gram-negative bacteria sutu found in the stomach, which can damage m enyebabkan prostaglandins that protect mucosal cells are in the stomach wall.
6.hCG
fluctuations in the levels of hCG (human chorionic gonadotrophin), especially since the period of gestational nausea or vomiting is most common in the first 12-16 weeks, which at the time, hCG reaches its highest levels. hCG with LH (luteinizing hormone) and secreted by trophoblast cells of the blastocyst. through the control of ovarian hCG in hipofisi and causes the corpus luteum continues to produce estrogen and progesterone, a function later taken over by the placenta chorionic layer. hCG can be detected in the blood of a woman of about 3 weeks of gestation (ie 1 week after fertilization), a fact which became the basis for most Basar kahamulan test.
7.hipotensi and a decrease in cerebral circulation
Immunological 8.Faktor
Leylek et al (1999) also found a correlation between high kadr hCG, thyroid hormone and imonoglobulin hiperemisis gravidarum in women compared with the high levels of control and significant in every parameter hiperemetik with accompanying tireksinemia. They concluded that the immunological activity during kahamilan may have played a role, or a triggering effect in the mechanism of stimulation of hCG in women hiperemisis gravidarum, with or without tiroktoksikosis.
9.Dampak the ability to smell or see
The theory that the kehamlan sickness may be a natural way to protect the fetus by preventing mothers not to eat foods that are harmful also been proposed (Sherman and Flaxman, 2002; Brown et al, 1997), the women become nauseated at the sight, smell or taste food that may potentially affect the fetus, and if food is eaten causing her to vomit out the food.
10.Migren and headache because serotonin play a role
11.Estrogen and progesterone
It has long been involved in the aetiology of nausea and vomiting, although this theory does not fully comply with isidensi symptoms in the first trimester in most wanuta, because the levels of this hormone continues to increase after passing the first 3 months.
12.Stimulasi pharyngeal vagal nerve
13.Mekanisme protective
14.Stimulasi sensory nerves in the stomach and duodenum
15.Serotonin (5-HT)
Serotonin acting on the gastrointestinal tract and the chemoreceptor trigger zone, as well as acetylcholine, dopamine, noradrenaline, histamine, and endorphins, are involved in normal gag reflex. Serotonin is secreted by the central nervous system, especially mesensefalon, hypothalamus, limbic system, cerebellum, and spinal cord grandula spinealis, and synthesized from tryptophan and secreted by the walls lambunh as a response to the food that causes contraction of the wall of the stomach during digestion. Suspected that serotonin plays a role in the physiology of sleep, appetite, migraine and headaches, mood setting sreta, also sick with various etiologies, although Borgeat et al (1997) failed to link the serotonin in the etiology of hiperemisis gravidarum.
16.Perubahan thyroid hormone
Asakura et al (2000) showed a correlation between high levels of thyroid hormones, non-esterified fatty acids and weight loss in women hiperemisis gravidarum compared with women who experience nausea, vomiting, mild to moderate in times of pregnancy.
17.Distensi, trauma or infection of the uterus, bladder or renal pelvis
18.Gangguan vestibular apparatus
Effects on the vestibular apparatus, as happened in nausea or vomiting caused by motion, also has a role, with many women who reported that any movement in particular sensory stimulation can trigger vomiting.
Nausea and vomiting depend on the interaction of many factors including the types of drug administered, emotional state, pain, tissue damage, movement atbu homeostasis change. To prevent vomiting, midwives must understand all the factors that affect the vomiting center. In childbirth, gastric stasis, pain and pressure on the stomach will be joined into one to cause symptoms of emesis. 

Vomiting center is influenced by:

a.Zona chemoreceptor trigger (CTZ: chemoreceptor trigger zone), which detects:
substances - chemicals that circulate in the blood such as estrogen, alcohol, nicotine, iron, opioids, drugs - drugs of anesthesia, the thyroid hormone.
Electrolyte imbalance (low sodium levels, including Addison's disease)
Cessation of regular alcohol consumption, the products of tissue damage are released into the blood circulation in the event of injury.
b.Nukleus vestibulars that detects:
Movement that includes ambulation and sudden movements, such as after childbirth or surgery.
c. Center - higher centers that detects:
Taste, smell, vision, emotion, nyari, fear, anxiety, anticipation, factors - individual factors.
d.Sistem autonomic nerves that detect:
Irritable bowel syndrome, throat or peritoneum, such as gastric stasis, or distention of the stomach (eg migraine, pain, childbirth), liver disease, some foods, alcohol.
e.Gangguan physiological such as:
Changes in blood pressure

• ph

• blood gas

• Blood glucose levels

• Pain, shock

• ketoacidosis, etc.

f.Kenaikan intra-cranial pressure (eg: pre-eclampsia, eclampsia) .

Predisposing Factors IMPROVEMENT severity of nausea and vomiting

1. . Fatigue
2. . Fetal women  
3. . Gastro-oesophageal reflux 
4. . Physiological changes in the gastrointestinal tract, mainly due to work progesterone, can cause problems, including cardiac sphincter relaxation (located between the esophagus and stomach), which menybabkan esophageal reflux and heartburn, and a decrease in peristaltic which cause constipation. Symptomatic gastroesophageal reflux tampaknta highly associated with nausea and vomiting. In one study, (Ho et al 1998), nearly 79% of women who experience heartburn or reflux reported nausea and vomiting have developed every day which generally appear in the first trimester and lost in the second trimester. 
5. . nausea and vomiting in a previous pregnancy 
6. . the use of contraceptive pills during preconception

Vellacont et al (1988) found that women with previous experience nausea when taking the contraceptive pill or during the premenstrual phase is more prone to gestational nausea or vomiting, although this can be caused by other factors, such as vitamin B6 and zinc deficiency, metabolism and excretion are possible influenced by the stressors that occur in the premenstrual period, or influenced by the contraceptive pill. .

    7.  premenstrual nausea 

    8. smoking
    9. stress, anxiety, and fear
  10. socio-economic problems
  11. difficulties in developing relationships
  12. a woman who has a mother who experienced nausea and vomiting during pregnancy. 

HOW TO OVERCOME NAUSEA VOMITING

 
Some tips to overcome the nausea-vomiting during early pregnancy:
1. Diets rich in protein and complex carbohydrates
2. Avoid the cause baud
3. Eat more often before you feel hungry
4. Eat dry biscuit before getting up in the morning when it was still lying
5. Sit upright after meals
6. Avoid greasy foods
7. Drinking carbonated beverages and herbal teas
8. Wake up slowly and avoid sudden movements
9. Avoid brushing your teeth after meals
10. Get extra sleep and relaxation as well as adequate rest .