Approach

The diagnosis of nausea and vomiting in pregnancy (NVP) is largely clinical. Typically, NVP begins between the fourth and seventh week after the last menstrual period and resolves in the second trimester. For a patient between 7 and 20 weeks estimated gestational age, no evaluation is necessary if the patient has the typical symptoms of nausea and vomiting but without signs of volume depletion or electrolyte imbalances. However, any patient demonstrating volume depletion or electrolyte imbalances should be evaluated for the presence of hyperemesis gravidarum (characterised by persistent vomiting, volume depletion and electrolyte imbalance, ketosis, and >5% weight loss) and to exclude alternative potentially serious aetiologies for their symptoms.

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