Vomiting in Pregnancy and Hyperemesis Gravidarum

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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 hrs. 
  • Input/output monitoring for 24–48 hrs. 
  •  Monitor electrolytes for 24hrs
  • Counselling and Reassurance  
  • Emotional support 
  • Rest and Lifestyle adjustment 
  • Ensure adequate hydration and Frequent small carbohydrate meal 

Pharmacological Treatment 

A: compound sodium lactate with 5% dextrose and 0.9%sodium chloride according to daily needs and severity.  

AND 

C: vitamin B1 (IV)100mg 24hourly mix in intravenous rehydration solution 

AND 

C: metoclopramide (IM) 5–10 mg 8hourly till vomiting stops.  

OR 

A: promethazine (IM) 12.5 mg 12hourly a day 

OR 

B: pyridoxine + doxylamine (FDC) (PO) 10mg/10mg 8hourly till 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.