See also: [[drugs in pregnancy]] > [!key points] Definition > - persistent, severe nausea and vomiting > - commencing <20 weeks gestation (peak 8-12 weeks) > - resulting in dehydration, electrolyte imbalance, ketosis, and weight loss of at least 5% of pre-pregnant weight > - no abdo pain > - ↑ risk in multiple pregnancy and trophoblastic disease > - diagnosis of exclusion > - exclude pyelo, gastro, UTI, DKA, appendicitis, hyperthyroidism > - **Rx:** pyridoxine 25mg TDS and doxylamine 12.5mg pd +/- maxalon # management - replace fluids - admit if - severe dehydration with intolerance of po - electrolyte issues - ketosis - infection ## antiemetics see [[drugs in pregnancy|drugs safe in pregnancy]] - pyridoxine - 25mg TDS or 200mg nocte orally - 50mg IV diluted TDS - doxylamine - 12.5 mg, usually combined with pyridoxine - metoclopramide (Cat A) - 10mg TDS or QID po - ondansetron (B1) - likely safe - use as second line agent - 4mg TDS po/IV - promethazine (Cat C) - prochlorperazine (Cat C) - 5mg TDS po - ginger - prednisolone (Cat A) - 40-60mg po daily then taper ==thiamine prior to any dextrose==