Excessive vomiting during pregnancy, associated with ketosis, dehydration and weight loss (>5% of pre-pregnancy
weight).
Cause
- Not known but may be common in multiple and molar pregnancy
Clinical features
- May occur from the 4th week of pregnancy and can continue beyond the 12th week
- Defining symptoms are nausea and vomiting so severe that oral intake is compromised
- Patient may develop complications of excessive vomiting, such as vomiting blood and dehydration
Differential diagnosis
- Intestinal obstruction
- Other causes of vomiting
- Molar pregnancy
Investigations
- Blood: complete count, RDT for malaria parasites
- Urinalysis: to exclude urinary tract infection
- Ultrasound scan: to detect molar or multiple pregnancies
MANAGEMENT
- IV fluids to correct dehydration and ketosis (give Ringer’s lactate or Normal saline and Glucose 5%)
- Promethazine 25 mg IM or orally every 8 hours prn
- Vitamin B6 (Pyridoxine) 1 tablet every 12 hours for 7 days
- Or Metoclopramide 10 mg IM or IV or orally every 6-8 hours prn and
If not responding to the above
- Chlorpromazine 25 mg IM or orally every 6 hours prn and refer