Nausea / vomiting of pregnancy (or "morning sickness")
Morning sickness is a misnomer as this can occur at any time. It affects about 80% of all pregnant women. The exact causes are unknown although likely mechanisms could include the following: the stomach starts to empty slower, and some pregnant women also become more sensitive to certain smells. This usually starts by about 6-7 weeks, peaks at 10 weeks and resolves by 12 weeks. More severe cases may start earlier and end later, and may be associated with dehydration from repeated vomiting. This is known as "hyperemesis gravidarum".
Treatment includes:
1. Rest - as tiredness makes nausea worse.
2. Regular small amount of fluid intake. Sucking ice cubes made from water or fruit juice may also help. Colder fluids may be easier to tolerate and may help to decrease the metallic taste in the mouth. Try to consume at least 2 litres of fluids daily.
3. Diet:
a) Take small frequent (every 1-2 hourly) meals.
b) Dry and savoury foods are usually better tolerated than sweet or spicy foods.
c) Cold meals may be better tolerated than hot ones.
d) Eat whatever you can tolerate. You may find liquid supplements, puddings and protein bars useful.
e) Eating and drinking separately may be helpful e.g. eat a small portion of food, wait for 20-30 minutes, then take some fluid
4. Identify triggers e.g. specific smells or situations, and avoid them. Multivitamins that contain iron and calcium may trigger nausea. These can be delayed till the second and third trimesters though it is still important to take the folic acid supplements.
5. Ginger (up to 1 g of fresh ginger root per day for 4 days) or ginger supplements (up to 1 g per day)may help reduce nausea and vomiting during pregnancy. There is very limited data on ginger and ginger supplements though they seem to work in some cases.Potential side effects of ginger include slightly increased risk of bleeding (especially if patient has vaginal bleeding or patient is on aspirin, other NSAIDs and/or low molecular weight heparin), allergy, and may be associated with dizziness, lower blood pressure, reduce blood sugar, irregular heart beat rhythm, diarrhea and heartburn.
6. Acupressure and acupuncture have been used with varying degrees of effectiveness.
7. Antacids treat heartburn and acid reflux which may exacerbate the nausea and vomiting. If still not better, stronger medications may be necessary.
8. Pyridoxine (vitamin B6) 25-50 mg every 8 hourly - safety has been confirmed for doses up to 200 mg / day.
9. Medications include metoclopramide 10 mg 3 times a day, Diclectin (up to 4 tablets a day), promethazine 12.5 - 25 mg every 4-6 hourly, dimenhydrinate 50-100 mg every 4-6 hourly (up to 200 mg per day), ondansetron 4-8 mg every 6-8 hourly, prochlorperazine 5-10 mg every 6-8 hourly.
10. When there is dehydration, intravenous (IV) fluid replacement with dextrose saline should be given. In addition, consider IV metoclopramide 5-10 mg every 8 hourly or IV promethazine 12.5-25 mg every 4-6 hourly. Lastly, consider IV methylprednisolone 15-20 mg every 8 hourly up to 24 hours or IV ondansetron 8 mg over 15 minutes every 12 hourly up to 24 hours.
Fatigue
It is believed that the high progesterone level during early pregnancy causes fatigue and tiredness during early pregnancy. Experience with fatigue is variable, and most common during the first trimester, tends to go away during the second trimester and returns in the third trimester.
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