nausea%20-and-%20vomiting%20in%20pregnancy
NAUSEA & VOMITING IN PREGNANCY
Nausea and 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 the last menstrual period and resolves by the 16th-20th 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:
    • 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
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