DDSEP® 8 Quick Quiz

DDSEP® 9 Quick Quiz

Publish date: January 29, 2021

Q2. A 26-year-old female who is 7 weeks pregnant presents with nausea and vomiting. She describes nausea that lasts most of the day with vomiting. She has tried rest and hydration, ginger supplementation, and a wrist band she purchased over the counter. However, she comes to clinic to request further management.

The most appropriate next step is:

Gastric-emptying study

Upper endoscopy

Ondansetron

A diet high in carbohydrates, low in protein

Doxylamine with vitamin B6

Q2. Correct answer: E


Rationale
This patient has nausea and vomiting of pregnancy (NVP), and has tried conservative management. Doxylamine and vitamin B6 have been found to be safe and effective for NVP and are considered first-line therapy. Further testing with gastric-emptying study is not necessary because NVP has a high prevalence at weeks 4-6 of gestation and peaks at week 9-16. A nuclear test such as gastric emptying is not appropriate during pregnancy, though decreased gastric emptying due to estrogen and progesterone is thought to be related to NVP. Upper endoscopy would be considered if the nausea and vomiting is refractory. Ondansetron can be considered, but there have been some questions raised regarding safety and it is not considered first line. Meals high in protein have been found to decrease nausea more that carbohydrate-rich meals.

Reference
ACOG Committee on Practice Bulletins-Obstetrics. Obstet Gynecol. 2018 Jan;131(1):e15-e30.

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