Nausea and Vomiting in the First Trimester

Ciprian P. Gheorghe, MD, PhD


March 26, 2012


The patient was diagnosed with nausea and vomiting of pregnancy. She was counseled on dietary changes, which included a bland diet and smaller, more frequent meals. She was prescribed vitamin B6 (25 mg every 8 hours) and doxylamine for use at bedtime.

One week later, the patient called and reported a worsening of symptoms, with almost complete inability to tolerate oral intake, persistent nausea, and weight loss. She was instructed to go to the emergency department for possible admission to the hospital.

In the emergency department, her examination showed:

  • Vital signs: temperature, 98.6°F; heart rate, 97 beats/min; blood pressure, 105/74 mm Hg;

  • General: fatigued;

  • Cardiovascular: tachycardia, regular rhythm, S1 and S2; no murmurs;

  • Pulmonary: lungs clear to auscultation bilaterally;

  • Abdomen: soft and nontender;

  • Skin: intact, no lesions; and

  • Pelvic: benign.

Laboratory studies of possible significance included:

  • Potassium level: 3.1 mEq/L;

  • Amylase level: 85 U/L;

  • Lipase level: 23 mIU/mL;

  • Beta-human chorionic gonadotropin (hCG) level: 135,123 mIU/mL; and

  • Urinalysis: large amount of ketones.

Establishing the Diagnosis

At this time, the patient was believed to have hyperemesis gravidarum and was admitted for intravenous hydration and antiemetics. An ultrasonogram was obtained (Figure).

Figure. Ultrasonogram showing molar pregnancy.

Molar pregnancy was diagnosed, and the patient was taken to the operating room for suction dilation and curettage. Postoperatively, she recovered well, and her nausea resolved. She was followed with serial beta-hCG measurement until her level was undetectable for 6 consecutive months. An intrauterine device was placed for long-term birth control.


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