Approach to the Patient with Nausea and Vomiting in Pregnancy

Abstract

A stepwise approach can be utilized for the assessment and treatment of nausea and vomiting in pregnancy and its most severe form, hyperemesis gravidarum. Prompt treatment is important to prevent further progression of symptoms. Diagnostic testing should focus on evaluation for signs of dehydration and electrolyte disturbance. In addition to volume and vitamin repletion, the use of antiemetic medications pyridoxine with doxylamine as first-line therapy is recommended for mild symptoms. Management of persistent/severe symptoms may include use of diphenhydramine, metoclopramide, ondansetron, and promethazine as second-line agents. Hospital admission is reserved for cases of refractory vomiting requiring continued intravenous antiemetics, failed outpatient management of symptoms, and severe fluid or electrolyte imbalance.