Nausea and vomiting in pregnancy

Please note that this guideline is only for use in pregnant women in the first trimester (up to 13+6 gestation) and those presenting for the first or second time. If the women are 14+ weeks gestation or presenting with the same symptoms for the third or more time, please refer directly to OBGYN medical staff at DGRI.

Points in history and examination

Rule out other causes:

Peptic ulcer
Cholecystitis
Gastroenteritis
Hepatitis
Pancreatitis
UTI
Metabolic
Neurological
Drug induced

Perform urinalysis

<2+ ketones

If tolerating oral fluids and no contraindications or allergies arrange outpatient management with oral anti-emetic.

Arrange face to face or telephone review after 48 hours.

First line

Cyclizine 50mg 8 hourly
Prochlorperazine 5-10mg 6-8 hourly
Promethazine 12.5-25mg 4-8 hourly
Chlorpromazine 10-25mg 4-6 hourly

Second line

Metoclopramide 5-10mg 8 hourly
Domperidone 10mg 8 hourly
Ondansetron 2-8mg 6-8 hourly (Avoid in first trimester)

2+ or more ketones

Refer to maternity assessment unit.

References

RCOG 2016 The management of nausea and vomiting of pregnancy and hyperemesis gravidarum (Green-top Guideline No.69) Full text