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  • Dr. Tara Dawn MD CCFP

Nausea and Vomiting in Pregnancy


SNAP SAMPs:

  1. Name TWO (2) non-pharmacological approaches to treat nausea and vomiting in pregnancy.

  2. Name the ONE (1) medication that is first line to treat nausea and vomiting in pregnancy.

  3. Name THREE (3) alternative medications to treat nausea and vomiting in pregnancy.

  4. How do you define Hyperemesis Gravidarium?

NVP is the single most common medical condition in pregnancy, affecting up to 90% of women. Hyperemesis Gravidarium occurs in 1% of patients. It is often cited by women as a large cause of anxiety as it can cause women to perform poorly at work or even miss work. It has been said that NVP is comparable to the severity of nausea experienced by patients undergoing chemotherapy!!! Being able to accurately recognize and treat NVP will prevent development of hyperemesis gravidarium, decrease maternal complications and reduce risk of the requirement of parental therapy/hospitalizations.

First Line Treatments (According to the 2002 SOGC Guidelines):

  • Dietary Advice

  • Separate solids and liquids

  • Eating small, frequent meals

  • Avoid fatty foods

  • Avoiding drinking cold, tart or sweet beverages

  • Lifestyle Advice

  • Increase sleep requirements

  • MANAGEMENT TIP: Be liberal as a provider to give work absence notes during the first trimester

  • Non-Pharmacological Therapies

  • Ginger Supplementation

  • MANAGEMENT TIP: Be honest with patients about efficacy of suggestions. As the evidence is that, at best, it will improve Nausea and Vomiting in one in three women, by 4 on a 40 point scale.

  • Acupuncture

  • Accupressure

  • MANAGEMENT TIP: Stimulation of the P6 point, located three-finger widths proximal to wrist has for thousands of years been used by acupuncturists to treat NVP! Thus, bands worn on the wrist can be offered to patients

  • Pharmacological Therapies

  • Doxylamine/Pyridoxine Combo

  • Diclectin 1 – 4 tablets daily

  • H1 Histamine Antagonists

  • Dimenhydrinate 50 – 100mg q4-6 hr PO/PR

  • MANAGEMENT TIP: In a patient with persistent NVP, consider the PER RECTUM route of medication administration.

Answers:

  1. Alternative Therapies: Dietary and lifestyle changes, Ginger Supplementation, Acupuncture, Acupressure

  2. Doxylamine/Pyridoxine Combination medications are the first line medication to treat NVP due to it’s excellent efficacy and safety.

  3. Second line Pharmacological treatments include (in order or proven fetal safety): Gravol PO/PR, Chloropromazine PO/IM, Promethazine IM/PO, Metoclopramide IM/PO or Ondansetron PO.

  4. Hyperemesis Gravidarum is defined as persistent nausea and vomiting that results in a greater than 5% weight loss, and is associated with electrolyte changes and urinary ketones.

Reference:

https://sogc.org/wp-content/uploads/2013/01/120E-CPG-October2002.pdf

http://www.cfp.ca/content/62/2/145.full.pdf+html


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