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ACOG Guidelines on Nausea Vomiting Of Pregnancy

ACOG Guidelines on Nausea Vomiting Of Pregnancy

The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins has released a document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy. The purpose of this document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy and it has been published online in Journal of Obstetrics & Gynecology. This is an update on  earlier one published in September 2015.

Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus and it should be distinguished from nausea and vomiting related to other causes.The symptoms of nausea and vomiting of pregnancy manifest before 9 weeks of gestation in almost all affected women. In case a pregnant woman  experiences nausea and vomiting for the first time after 9 weeks of gestation, other conditions should be considered in the differential diagnosis including  cholelithiasis or diabetic gastroparesis.

Nausea and vomiting affecting women during pregnancymay range from mild  retching to a more severe form  hyperemesis gravidarum, Hyperemesis gravidarum can be debilitating and deplete a woman’s nutrition and is most common indication for admission to the hospital during the first part of pregnancy .Hyperemesis gravidarum  is diagnosed by exclusion with  patient having severe and persistent vomiting not related to other causes leading to  acute starvation and ketonuria. There may be   weight loss to the tune of   at least 5% of pre -pregnancy weight. This may be accompanied by Electrolyte, thyroid, and liver abnormalities .

Level A recommendations :

  1. Pregnant women should use Vitamin B6 (pyridoxine) alone or in combination with doxylamine as first-line pharmacotherapy.
  2. Women  should be encouraged to take prenatal vitamins for 1 month before fertilization as it may decrease the incidence and severity of nausea and vomiting during pregnancy.
  3. The American College of Obstetricians and Gynecologists does not  recommend any antithyroid medication  for abnormal maternal thyroid tests caused by gestational transient thyrotoxicosis or hyperemesis gravidarum, or both, and .

Level B recommendations:

  1. Ginger is a nonpharmacologic treatment as it has been found useful in the treatment of nausea and vomiting of pregnancy.
  2. Methylprednisolone may be used in severe nausea and vomiting of pregnancy as a last-resort because of its risk profile.

Level C recommendations:

  •  The treatment of nausea and vomiting of pregnancy should be instituted early as it may prevent it from progressing to a serious form of hyperemesis gravidarum.
  • Intravenous hydration ought to be given  to patients who are unable to tolerate oral fluids for a prolonged period leading to dehydration 
  • Strongly consider correction of ketosis and vitamin deficiency. Include dextrose and vitamins in therapy in cases of prolonged vomiting; consider administering thiamine before dextrose infusion to prevent Wernicke encephalopathy.
  • All those women with hyperemesis gravidarum who do not respond to medical therapy and  are  not able to maintain their weight, enteral tube feeding (nasogastric or nasoduodenal) should be started as first-line treatment to support nutrition .
  • Only as a last resort in women with hyperemesis gravidarum,  peripherally inserted central catheters may be used as serious  complications are associated with this intervention leading to  maternal morbidity.

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Dr. Kamal Kant Kohli

Dr. Kamal Kant Kohli

A Medical practitioner with a flair for writing medical articles, Dr Kamal Kant Kohli joined Medical Dialogues as an Editor-in-Chief for the Speciality Medical Dialogues. Before Joining Medical Dialogues, he has served as the Hony. Secretary of the Delhi Medical Association as well as the chairman of Anti-Quackery Committee in Delhi and worked with other Medical Councils of India. Email: Contact no. 011-43720751
Source: ACOG

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