What Can U Take for Nausea When Pregnant

Nausea and vomiting affect up to 80% of pregnant women. Symptoms are most common and most severe during the 1st trimester. Although common usage refers to morning sickness, nausea, vomiting, or both typically may occur at any point during the day. Symptoms vary from mild to severe (hyperemesis gravidarum).

The pathophysiology of nausea and vomiting during early pregnancy is unknown, although metabolic, endocrine, gastrointestinal, and psychologic factors probably all play a role. Estrogen may contribute because estrogen levels are elevated in patients with hyperemesis gravidarum.

• Morning sickness (most common)

• Hyperemesis gravidarum

Vomiting can also result from many nonobstetric disorders. Common causes of acute abdomen (eg, appendicitis, cholecystitis) may occur during pregnancy and may be accompanied by vomiting, but the chief complaint is typically pain rather than vomiting. Similarly, some central nervous system (CNS) disorders (eg, migraine, CNS hemorrhage, increased intracranial pressure) may be accompanied by vomiting, but headache or other neurologic symptoms are typically the chief complaint.

Evaluation of patients with nausea and vomiting during early pregnancy aims to exclude serious or life-threatening causes of nausea and vomiting. Morning sickness (uncomplicated nausea and vomiting) and hyperemesis gravidarum are diagnoses of exclusion.

History of present illness should particularly note the following:

• Onset and duration of vomiting

• Exacerbating and relieving factors

• Type (eg, bloody, watery, bilious) and amount of emesis

• Frequency (intermittent or persistent)

Important associated symptoms include diarrhea, constipation, and abdominal pain. If pain is present, the location, radiation, and severity should be queried. The examiner should also ask what social effects the symptoms have had on the patient and her family (eg, whether she is able to work or to care for her children).

Review of systems should seek symptoms of nonobstetric causes of nausea and vomiting, including fever or chills, particularly if accompanied by flank pain or voiding symptoms (urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys (pyelonephritis), and lower tract infections, which involve the bladder (cystitis), urethra... read more or pyelonephritis), and neurologic symptoms such as headache, weakness, focal deficits, and confusion (migraine Migraine Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 hours and may be severe. Pain is often unilateral, throbbing, worse with exertion, and accompanied by symptoms... read more or CNS hemorrhage Intracerebral Hemorrhage Intracerebral hemorrhage is focal bleeding from a blood vessel in the brain parenchyma. The cause is usually hypertension. Typical symptoms include focal neurologic deficits, often with abrupt... read more ).

Past medical history includes questions about morning sickness or hyperemesis in past pregnancies. Past surgical history should include questions about any prior abdominal surgery, which would predispose a patient to mechanical bowel obstruction.

Drugs taken by the patient are reviewed for drugs that could contribute (eg, iron-containing compounds, hormonal therapy) and for safety of these drugs taken during pregnancy.

Examination begins with review of vital signs for fever, tachycardia, and abnormal blood pressure (too low or too high).

The following findings are of particular concern:

• Abdominal pain

• Signs of dehydration (eg, orthostatic hypotension, tachycardia)

• Fever

• Bloody or bilious emesis

• No fetal motion or heart sounds

• Abnormal neurologic examination

• Persistent or worsening symptoms

Vomiting is less likely to be due to pregnancy if it

• Begins after the 1st trimester

• Is accompanied by abdominal pain, diarrhea, or both

Abdominal tenderness may suggest acute abdomen. Meningismus, neurologic abnormalities, or both suggest a neurologic cause.

Vomiting is more likely to be due to pregnancy if

• It begins during the 1st trimester.

• It lasts or recurs over several days to weeks.

• Abdominal pain is absent.

• There are no symptoms or signs involving other organ systems.

Patients with significant vomiting, signs of dehydration, or both usually require testing. If hyperemesis gravidarum is suspected, urine ketones are measured; if symptoms are particularly severe or persistent, serum electrolytes are measured. If fetal heart sounds are not clearly audible or detected by fetal Doppler, pelvic ultrasonography should be done to rule out hydatidiform mole.

Pregnancy-induced vomiting may be relieved by drinking or eating frequently (5 or 6 small meals/day), but only bland foods (eg, crackers, soft drinks, BRAT diet [bananas, rice, applesauce, dry toast]) should be eaten. Eating before rising 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, dextrose IV may be added to maintenance fluid if oral intake remains limited. Before administration of dextrose, thiamin 100 mg IV should be given to prevent Wernicke encephalopathy.

Vitamin B6 is used as monotherapy; other drugs are added if symptoms are not relieved. Extended-release doxylamine plus pyridoxine can be given to women who do not respond to initial therapy.

Ginger (eg, ginger capsules 250 mg orally 3 or 4 times a day, ginger lollipops), 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 Gynecol 198 (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 Nutr 38 (5):595–601, 2014. doi: 10.1177/0148607113489994 Epub 2013 May 28. PMID: 23715775.

• Vomiting during pregnancy is usually self-limited and responds to dietary modification.

• Hyperemesis gravidarum is less common but is severe, leading to dehydration, ketosis, and weight loss.

• Consider nonobstetric causes of nausea and vomiting.

What Can U Take for Nausea When Pregnant

Source: https://www.msdmanuals.com/professional/gynecology-and-obstetrics/symptoms-during-pregnancy/nausea-and-vomiting-during-early-pregnancy

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