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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Nausea and Vomiting in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
3. Management of Mild Nausea and Vomiting of Pregnancy
Case Scenario
Mrs. B is a 24 y/o G1P0 at 10 weeks by her dates who presents to her first prenatal visit complaining of morning sickness. Her symptoms are not incapacitating, but she would like to feel better. She has tried various herbal teas without much relief.
Your most useful recommendation at this initial visit would be?
Try the following in a stepwise or cumulative fashion:
- Advise the patient to temporarily discontinue her prenatal vitamins with iron if she feels they are upsetting her stomach.
- Make dietary adjustments (small, frequent, low fat meals, etc.).
- Avoidance of triggers
- Try alternative therapies such as ginger, chamomile, or peppermint teas. (Acupressure at the wrist P6 locus has not been shown to be superior to placebo in the available aggregate data.)
- Prescribe pyridoxine (vitamin B6) 25 mg po tid.
- Add the H1-receptor blocker doxylamine 12.5 mg po tid if needed.
- Anti-emetic for p.r.n. use if intermittent more severe symptoms.
Prescribe a phenothiazine: promethazine 12.5-25 mg po/pr
Prescribe an antihistamine: hydroxyzine 12.5-25 mg po
If symptoms persists despite the above methods, consider adding:
- metoclopramide 5-10 mg po tid,
- a cholinomimetic agent / anti-dopamanergic
- (manufacturer’s nonrandomized study demonstrated 78 % efficacy)
- if relief is not obtained, consider the 5-HT-3 receptor inhibitor, dolasetron 25-100 mg po tid.
- (expensive, over 80 % effective in only randomized controlled trial)
(None of the above medications have been associated with an increased risk of fetal malformations. See page 9 )
