Nausea and vomiting in pregnancy

Last reviewed: 28 Aug 2023
Last updated: 17 Jan 2023



History and exam

Key diagnostic factors

  • first trimester of pregnancy
  • weight loss of >5%
More key diagnostic factors

Other diagnostic factors

  • absence of thyroid enlargement/nodules
  • dry mucous membranes
  • postural dizziness
  • tachycardia
  • hypotension
  • ketotic breath
Other diagnostic factors

Risk factors

  • family history of hyperemesis gravidarum
  • previous history of NVP
  • multiple gestation or increased placental mass
  • gestational trophoblastic disease
  • other causes of increased placental mass
  • female fetus
  • history of motion sickness
  • history of migraine headache
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • CBC
  • basic metabolic panel
  • serum LFTs
  • serum BUN and creatinine
  • serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
  • urinalysis
  • urine or serum ketones
  • fetal ultrasound with nuchal translucency
  • serum analytes
  • Helicobacter pylori breath test
  • urine culture
  • serum amylase and lipase
  • abdominal ultrasound
  • renal ultrasound
  • cranial CT or MRI
More investigations to consider

Treatment algorithm


without volume depletion

without volume depletion but failed conservative management

with volume depletion



Jeffrey D. Quinlan, MD, FAAFP

Professor and Chair

Family Medicine

Carver College of Medicine

University of Iowa

Iowa City



JDQ declares that he has no competing interests.

Peer reviewers

Sarah Jorgensen, DO

Faculty Physician

Family Medicine Residency

Naval Hospital Jacksonville



SJ declares that she has no competing interests.

Yosra Tahir Jarjees, MD

Assistant Professor

Head of Department of Obstetrics and Gynecology

Mosul College of Medicine




YTJ declares that he has no competing interests.

D. Ashley Hill, MD

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital




DAH declares that he has no competing interests.

  • Differentials

    • Viral gastroenteritis
    • Food poisoning
    • Cholecystitis
    More Differentials
  • Guidelines

    • Nausea and vomiting of pregnancy
    • The management of nausea and vomiting of pregnancy and hyperemesis gravidarum
    More Guidelines
  • Patient leaflets

    Morning sickness

    Morning sickness: questions to ask your doctor

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer