Run Time: 4 minutes
Author: Peter Bakes M.D.
- The American College of Obstetrics and Gynecology (ACOG) has new recommendations on the management of nausea and vomiting in pregnancy. This can present in any form along the spectrum from morning sickness to hyperemesis gravidarum.
- Conventional management of any nausea in the ED is usually Zofran. Zofran has been linked to causing prolonged QT placing a pregnant woman at risk of developing Torsades, ventricular fibrillation, or cardiac arrest. There is good data from Sweden and Denmark that the relative risk of cardiac and septal defects in the fetus increases with administration of Zofran during the first trimester!
- ACOG recommends the first line treatment against nausea in pregnancy is prescribing two pills at night of Diclegis. If that is not effective, another dose can be taken in the morning and the afternoon.
- The second line treatment is Dramamine or Benadryl and the third line of is Reglan. If this does not work, Phenergan and Zofran are rescue medications that can be used! This marks a significant change in guidelines and should change our practice!