This week on the podcast we examine the common and very troublesome problem of vomiting in pregnancy, from mild morning sickness to the more severe hyperemesis gravidarum.
Take home messages:
Standard investigations include FBC, UEC, LFT, TFTs, urinalysis and obstetric ultrasound
In severe cases, consider secondary causes of vomiting such as urosepsis, GI or neurological pathology
Dietary advice, ginger and P6 acupressure have mixed evidence but are unlikely to do harm
Pyridoxine (vitamin B6) and doxylamine have the best evidence for safety and efficacy and should be used first line
Second line options include metoclopramide, prochlorperazine and promethazine which are all considered safe in early pregnancy
If significant ketonuria, electrolyte imbalance or dehydration, refer for intravenous hydration, parenteral anti-emetics and thiamine