Nausea%20-and-%20vomiting%20in%20pregnancy Treatment
Supportive Therapy
- Consider inpatient treatment for pregnant patients with the following:
- Inability to take oral antiemetics
- Persistently abnormal vital signs
- Changes in mental status
- Severe dehydration and unable to tolerate oral fluids
- Severe electrolyte abnormality and acidosis
- Malnutrition
- Presence of infection and unable to tolerate oral antibiotics
Rehydration
- Warranted when dehydration, electrolyte abnormalities, or acid-base disturbances are demonstrated or if patient is unable to tolerate oral liquids
- Intravenous (IV) fluids, eg normal saline or Ringer’s lactate solution
- Maintain urine output to >100 mL/hr
- Urea and serum electrolyte levels should be monitored while on IV fluids
- Correction of electrolyte imbalance includes magnesium, calcium, potassium, and phosphorus
- IV Thiamine initially with the rehydration fluid then daily for 2-3 days followed by IV multivitamin or as per local protocol should be considered in women who require IV hydration and who have vomited for >3 weeks
- Multivitamin IV supplementation especially Thiamine prevents Wernicke’s encephalopathy
Enteral (EN) or Parenteral Nutrition (PN)
- A last resort measure and monitored in centers with the ability to provide home parenteral therapy
- EN should be considered in the dehydrated patient or those with significant or persistent weight loss who are unresponsive to antiemetics
- Should be initiated as a slow, continuous, isotonic infusion
- PN is used when EN is not tolerated