These are common during pregnancy but may be aggravated by strong smells (food, garbage, machine oil, etc.) and motion.

Symptoms appear quite early and are usually mild, require no treatment, and disappear by the 16th week or sooner.

Occasionally, these symptoms are severe and require intervention.

If a pregnant woman states, “I can’t keep anything down,” and has ketones in her urine, she must be re-hydrated with crystalloid such as 5% dextrose in lactated Ringer’s solution (D5LR). One liter is given in a short time (15-20 minutes), and the second liter given over an hour or two. Sometimes a third liter, given over several hours, will be necessary.

While this rate of hydration would be much too fast for an older individual with heart disease, the cardiovascular system of a young, healthy, pregnant woman is very “stretchy” and will tolerate such rapid infusions well.

After IV therapy, the woman is generally feeling much better and can return to her duties. If this rehydration is insufficient to suppress her symptoms, then a more prolonged course of therapy is recommended.

Try to avoid antiemetics in the pregnant patient as the long-term consequences of most of the drugs on a developing pregnancy are not well established. Nonetheless, the long-term results of protracted vomiting, dehydration, electrolyte imbalance and ketosis are known and unfavorable to the pregnancy, so if it appears that IV hydration alone is not controlling the symptoms, move quickly to antiemetics.

Conventional doses of Antihistamines (Benadryl), Anticholinergics (Scopolamine), Compazine, Phenergan, and others have all been used to good advantage in these situations. Ginger capsules can be effective and Zofran can be highly effective.

Rarely, more aggressive management, which may include parenteral feedings, will be necessary to control symptoms and maintain nutrition.

Sometimes, an underlying cause or aggravating factor can be identified. Among these are:

• Gestational Trophoblastic Disease
• Multiple Gestation
• Hypercalcemia associated with hyperparathyroidism