nausea%20-and-%20vomiting%20in%20pregnancy
NAUSEA & VOMITING IN PREGNANCY
Nausea & vomiting in pregnancy (NVP), commonly known as "morning sickness", affects 50-90% of pregnant women.
In most women, the condition manifests between the 4th-7th week after last menstrual period and resolves by the 16th week of gestation.
It manifests in a spectrum of severity from mild nausea to very rare life-threatening symptoms.
The etiology is multifactorial.
The pregnant woman's sense of well-being and her daily activities are greatly affected by nausea and vomiting; the physical and emotional impact often leads to anxiety and worry about the effect of the symptoms on the fetus and reduced job efficiency.

Supportive Therapy

Consider inpatient treatment for pregnant patients with the following:

  • Persistently abnormal vital signs
  • Severe dehydration unable to tolerate oral fluids
  • Severe electrolyte abnormality and acidosis
  • Malnutrition
  • Presence of infection and unable to tolerate oral antibiotics
  • Inability to take oral antiemetics

Supportive Measures

Rehydration

  • Warranted when dehydration, electrolyte abnormalities, or acid-base disturbances are demonstrated
  • Intravenous (IV) Fluids
    • Normal saline or Ringer’s lactate, maintain urine output to >100 mL/hour
    • Urea and serum electrolyte levels should be monitored while on IV fluids
  • Correction of electrolyte imbalance including magnesium, calcium, potassium, and phosphorus
  • Multivitamin IV supplementation especially thiamine to prevent Wernicke’s encephalopathy

Enteral (EN) or Parenteral Nutrition (PN)

  • As a last resort measure and monitored in centers with the ability to provide home parenteral therapy
  • Indicated for patients with persistent weight loss despite use of noninvasive therapies
  • EN should be initiated as a slow, continuous, isotonic infusion
  • PN is used when EN is not tolerated
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