gynecology and obstetrics
Nausea and Vomiting During Early Pregnancy
Treatment
Pregnancy-induced nausea and vomiting is relieved in some patients by drinking or eating frequently (5 or 6 small meals/day) and/or eating only bland foods (eg, crackers, BRAT diet [bananas, rice, applesauce, dry toast]). Eating before getting out of bed in the morning may help. If dehydration (eg, due to hyperemesis gravidarum) is suspected, 1 to 2 L of normal saline or Ringer’s lactate is given IV, and any identified electrolyte abnormalities are corrected. After initial fluid resuscitation,dextroseIV may be added to maintenance fluid if oral intake remains limited. Before administration ofdextrose,thiamine100 mg IV should be given to prevent Wernicke encephalopathy. Certain drugs (see table) can be used to relieve nausea and vomiting during the 1st trimester without evidence of adverse effects on the fetus. Rarely, weight loss continues and symptoms persist despite treatment. In such cases, enteral nutrition via a nasogastric or nasoduodenal tube may be considered. Peripherally inserted central catheters are associated with a high rate of infection and thromboembolism in pregnancy and should be avoided ( Treatment references , Vitamin B6 is used as monotherapy; other medications are added if symptoms are not relieved. Extended-releasedoxylaminepluspyridoxinecan be given to women who do not respond to initial therapy. Ginger(eg,gingercapsules 250 mg orally 3 or 4 times a day,gingerlollipops), acupuncture, motion sickness bands, and hypnosis may help, as may switching from prenatal vitamins to a children’s chewable vitamin with folate. 1.Holmgren C, M Aagaard-Tillery KM, Silver RM, et al: Hyperemesis in pregnancy: An evaluation of treatment strategies with maternal and neonatal outcomes.Am J Obstet Gynecol198 (1):56.e1–4, 2008. doi: 10.1016/j.ajog.2007.06.004 2.Cape AV, Mogensen KM, Robinson MK, Carusi DA: Peripherally inserted central catheter (PICC) complications during pregnancy.JPEN J Parenter Enteral Nutr38 (5):595–601, 2014. doi: 10.1177/0148607113489994 