Vomiting in pregnancy and hyperemesis gravidarum- Management

Vomiting in pregnancy and hyperemesis gravidarum- Management

It is excessive nausea and vomiting in early pregnancy requiring hospital admission and rehydration.

Clinical presentation

• Weight loss

• Excessive nausea and vomiting typically in early pregnancy

• Dehydration

• Altered general status (fast pulse, restlessness)

Investigations

• Full blood count

• Blood for urea, electrolytes and serum creatinine

• Urinalysis, micro urine and culture, ketonuria

• Liver function tests

• Thyroid function tests

• Obstetric ultrasound to exclude multiple pregnancy and GTD

Non-pharmacological treatment

• Nil per oral (nothing by mouth) for 24–48 hours

• Input/output monitoring for 24–48 hours

• Monitor electrolytes for 24 hours

• Counselling and reassurance

• Emotional support

• Rest and lifestyle adjustment

• Ensure adequate hydration and frequent small carbohydrate meals

Pharmacological treatment

• Compound sodium lactate with 5% dextrose and 0.9% sodium chloride according to daily needs and severity AND

• Vitamin B1 (IV) 100 mg 24 hourly mixed in intravenous rehydration solution AND

• Metoclopramide (IM) 5–10 mg 8 hourly until vomiting stops AND

• Promethazine (IM) 12.5 mg 12 hourly AND

• Pyridoxine + doxylamine (FDC) (PO) 10 mg/10 mg 8 hourly until vomiting stops

Referral

Depends on the status of the patient. Refer to a hospital if vomiting is intractable and if there is a need for high volume replacement.