Nausea and vomiting in pregnancy

Last reviewed: 1 Sep 2022
Last updated: 12 Feb 2020

Summary

Definition

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
  • absence of central nervous system (CNS) signs
  • 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

  • complete blood count
  • basic metabolic panel
  • serum liver function tests
  • 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
More 1st investigations to order

Investigations to consider

  • urine culture
  • serum amylase and lipase
  • abdominal ultrasound
  • renal ultrasound
  • cranial CT or MRI
More investigations to consider

Treatment algorithm

ACUTE

without volume depletion

without volume depletion but failed conservative management

with volume depletion

Contributors

Authors

Jeffrey D. Quinlan, MD

Associate Professor

Family Medicine

Uniformed Services University of Health Sciences

Bethesda

MD

Disclosures

JDQ declares that he has no competing interests.

Peer reviewers

Sarah Jorgensen, DO

Faculty Physician

Family Medicine Residency

Naval Hospital Jacksonville

FL

Disclosures

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

Mosul

Iraq

Disclosures

YTJ declares that he has no competing interests.

D. Ashley Hill, MD

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital

Orlando

FL

Disclosures

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