Definition
- Persistent vomiting in pregnancy which causes weight loss (>5% of pre-pregnancy weight) and ketosis (oxford handbook of clinical medicine)
Investigations
- Urine dip → ketones and UTI (+send MSU)
- FBC → ↑ haematocrit
- U&E → to exclude hypokalaemia and hyponatraemia
- U/S → to diagnose multiple gestations and molar pregnancy
Treatment
Mild
- Ginger may be helpful in doses of 250 mg up to 4 times per day
- Pyridoxine 50 mg 6-hourly or metoclopramid 10 mg two to three times a day
Moderate and Severe
- Hospital admission
- IV infusion 1L of 5% dextrose followed by 1L Hartmann’s solution (if electrolyte disturbances)
- Measure fluid intake and output and check urine twice daily for acetone, bile, sugar and specific gravidity
- If vomiting persists:
- Metoclopramide 10mg IV or IM as needed
- Withheld oral feeding (can be given ice to suck)
- Discharge when:
- Remain in hospital for 2 days after vomiting has ceased /and/ until she has begun to gain weight
Sources
- Baldwin, Hjelde & Goumalatsou et al. (2016) Oxford Handbook of Clinical Specialties, Oxford University Press. Page 17
- FRANZCOG (2016) Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology, Elsevier. Chapter 10