Nausea%20-and-%20vomiting%20in%20pregnancy Treatment

• 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