PO fluids if able to tolerate
IV fluid repletion (use D5NS in the setting of ketonuria)
ACOG recommends a stepwise approach to nausea and vomiting in pregnancy
Vitamin B6 10-25mg q6-8hrs
ADD Doxylamine 12.5mg q6-8hrs
ADD Promethazine 12.5-25mg q4hrs PO or PR
ADD Dimenhydrinate 50mg q4-6hrs IV OR metoclopramide 5-10mg q8hrs IV OR promethazine 12.5-25mg q4hrs IV
ADD Methylprednisolone 16mg q8hrs PO or IV for 3 days and taper to effective dose OR ondansteron 8mg (or 4mg) q12hrs IV
If using ondansetron, reasonable to have a discussion about claimed risks of birth defects.
First-trimester exposure to ondansetron was not associated with cardiac or congenital malformations but was associated with a small increased risk of oral clefts.
If using ondansetron, reasonable to have a discussion about claimed risks of birth defects.
First-trimester exposure to ondansetron was not associated with cardiac or congenital malformations but was associated with a small increased risk of oral clefts.
Hyperemesis gravidarum
Placenta accreta
Gastroenteritis
Eclampsia
Biliary disease
Preeclampsia
Ectopic pregnancy
Postpartum hemorrhage