Nausea and/or vomiting are common in early pregnancy, affecting 70-85% of pregnant women.  According to ACOG, some pregnant women have a higher risk of having hyperemesis gravidarum.  They include women carrying multiple fetuses, daughters and sisters of women who had the condition, women carrying a female fetus, and women with a history of hyperemesis gravidarum in a previous pregnancy.  Other risk factors include a history of motion sickness or migraines.  If it persists, consider referral for evaluation.    

 

1.       Try ginger preparations

2.       Avoid fatty, greasy, and highly seasoned food

3.       Open windows when cooking.  Avoid strong odors.  Some women find sniffing a lemon helpful.

4.       Eat smaller frequent meals, drinking fluids between meals

5.       Eat dry toast or crackers before arising

6.       Eat long acting protein food sources at bedtime (e.g. cheese, peanut butter)

7.       If none of these are effective, try the following:

·       Discontinue taking the prenatal vitamin if it tends to aggravate the morning sickness.  You may resume taking them when you are feeling better.  Two (2) chewable pediatric vitamins per day or folic acid, 1 mg daily may be used.

 

·       Emetrol - 1 tablespoon on empty stomach every 15 minutes x 2 doses.

 

·       Vitamin B6 25 mg 3 to 4 times a day

 

·       If Vitamin B6 not effective alone, add Unisom (doxylamine) 25 mg, 3 to 4 times a day.  Adjust doses of both medicines as needed.  This drug has been extensively studies and there are no data to suggest that Unisom (doxylamine) causes birth defects; however, the label does not recommend use during pregnancy

 

 

 

 

 

 

 

 

 

 

8.       Refer patient if:

·       There is a significant weight loss (5 lbs or more from baseline)

·       Patient becomes dehydrated and/or has persistent ketonuria (Ketonuria that does not clear with hydration)

·       Persistent nausea and vomiting beyond 20 weeks

 

 

 

9.       After evaluation by a physician, one of the following may also be prescribed:

 

1.       Phenergan

 

2.       Compazine

 

3.               Zofran

 

 

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

                                     ______                                                                                          Director

 

 

___________________________                                     Date

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.

Morning Sickness

 

1.       Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.  Obstet Gynecol. 1991; 78:33-36.

 

2.       Nausea and vomiting of pregnancy, ACOG Practice Bulletin No.52.  American College of Obstetricians and Gynecologist.  Obstet Gynecol 2004;103:803-15.