Nausea and vomiting in pregnancy is common and at best an unpleasant experience for the patient, and at worst can be life threatening. It normal starts @ 4-7/40, peaks @ 9/40, and finishes @ 20/40.
We need to conduct a thorough history and examination looking for causes other than a high βHCG. these include:
- Abdominal pathology
- Urinary pathology
- Infections
- Drug History
- Chronic H.Pylori
Testing
- Ketones (RCOG state – ketones should not be relied upon over and above clinical symptoms)
- FBC
- U&E
- Glucose
- MSU/Urine dip
- PUQE-24 score
PUQE-24 score
RCOG Algorithm
We don’t have an ambulatory pathway at our trust! However, our Gynae, colleagues suggest following:
In ED hydration and symptom control if the patients clinic picture improves & urine ketones <2+ discharge from ED could be considered. Otherwise ref to Gynae team for 4c.
Inpatient management should be considered if there is ≥1 of the following:
- Continued nausea and vomiting and inability to keep down oral antiemetics
- Continued nausea and vomiting associated with ketonuria and/or weight loss (greater than 5% of body weight), despite oral antiemetics
- Confirmed or suspected comorbidity (such as urinary tract infection and inability to tolerate oral antibiotics)
Recommended Antiemetics
Ginger has been shown to reduce nausea and vomiting, and may be a n alternative if patients with mild symptoms who don’t wish to take medication.
Ondansetron WARNING: MHRA (Medicines & Healthcare products Regulatory Agency) has recently published a warning regarding the use of ondasetron in early pregnancy.leading to a small but significant risk of cleft lip
RCOG – The Management of Nausea andVomiting of Pregnancy and Hyperemesis Gravidarum
