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Gynecologic and Obstetric Disorders

Vomiting of Pregnancy and Hyperemesis Gravidarum

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

Hyperemesis gravidarum

  • Persistent, severe vomiting
  • Weight loss, dehydration, hypochloremic alkalosis, hypokalemia.
  • May have transient elevation of liver enzymes
  • Appears related to high or rising serum HCG
  • More common with multi-fetal pregnancies or hydatidiform mole

Management: A) Mild nausea and vomiting of pregnancy

  • In most instances, only reassurance and dietary advice are required. Ask the patient to take care of diet, eat small frequent meals, eat when hungry, avoid fatty and spicy foods and emetogenic foods and smell, eliminate pills with iron, use herbal teas like peppermint and ginger and frozen desserts.
  • Because of possible teratogenicity, drugs used during the 1st half of pregnancy should be restricted to those of major importance to life and health.
  • Tab Femiroz/ Pregnova (Doxylamine + pyridoxine) 10/10mg, 2 Tab PO OD at bed time OR
  • Tab Novidoxine (Meclizine+Pyridoxine) 25/50 mg, 1 tab PO OD at bed time.
  • Antiemetics, antispasmodics and antihistamines are generally unnecessary to treat nausea of pregnancy.

B) Hyperemesis Gravidarum

  • With more severe nausea and vomiting, it may become necessary to hospitalize the patient. In this case, a private room with limited activity is preferred.
  • It is recommended to give nothing by mouth until the patient is improving, and maintain hydration and electrolyte balance by giving appropriate parenteral fluids and vitamin supplements as indicated.
  • Inj/syp Promethazine (Phenargan) 25mg orally or rectally or IV QID OR

Inj/tab Maxolon (Metoclopromide) 5-10mg PO or IV QID OR

Inj/tab Ondansetron (Onset) 4-8mg orally or IV TDS

  • As soon as possible, the patient should be placed on a dry diet consisting of six small feedings daily
  • Antiemetics may be continued orally as needed
  • After in-patients stabilization, the patient can be maintained at home even if she requires IV fluids in addition to her oral intake.

When to Refer

  • Patients does nit respond to 1st line outpatient management.
  • There is concern for other pathology (i.e., Hydatidiform mole).

When to Admit

  • Patient is unable to tolerate any food or water
  • Patient cannot ingest necessary medications
  • Weight loss
  • Presence of a hydatidiform mole