Management of Vomiting at 14 Weeks of Pregnancy
Assessment of Severity
- The American College of Gastroenterology recommends assessing severity using the Motherisk Pregnancy-Unique Quantification of Emesis (PUQE) score to guide management, with scores categorized as mild (≤6), moderate (7-12), and severe (≥13) 1
- Evaluate for signs of hyperemesis gravidarum (HG), which includes dehydration, weight loss >5% of prepregnancy weight, and electrolyte imbalances 3
Initial Management for Mild to Moderate Symptoms
- Dietary modifications, such as eating small, frequent, bland meals, following the BRAT diet, and focusing on high-protein, low-fat meals, are recommended 1, 2, 3
- Vitamin B6 (pyridoxine) 10-25 mg every 8 hours is recommended as first-line pharmacologic therapy, with the addition of doxylamine if symptoms persist 1, 2
Management for Moderate to Severe Symptoms
- For symptoms not responding to first-line therapy, consider H1-receptor antagonists (promethazine, dimenhydrinate), metoclopramide, and ondansetron, with metoclopramide shown to have similar efficacy to promethazine with fewer side effects 2, 3
- Intravenous fluid and electrolyte replacement, vitamin B1 (thiamine) supplementation, and intravenous glucocorticoids may be required in severe cases 2, 3
Special Considerations
- Early intervention is crucial to prevent progression to hyperemesis gravidarum, with symptoms typically peaking at 8-12 weeks and subsiding by week 20 1, 2
- Monitor for complications of severe vomiting, including electrolyte abnormalities, nutritional deficiencies, and liver function abnormalities, seen in 40-50% of HG patients 3