Hyperemesis Gravidarum

Q: 28 years old female with 12 weeks of pregnancy is admitted to ICU with hypotension and severe hypovolemia secondary to hyperemesis gravidarum. Which of the following is considered as the first line of treatment in hyperemesis gravidarum? 

A) metoclopramide
B) prochlorperazine
C) promethazine
D) droperidol
E) dexamethasone 


Answer: C

Experts have tried to find the best approach for a wide range of nausea stimulators depending on neurotransmitters. Unfortunately, so far no specific neurotransmitter can be identified for pregnancy-related severe nausea. But promethazine is found to be most effective and considered as the first line of treatment in hyperemesis gravidarum. Serotonin antagonists and corticosteroids are considered as second-line agents. Interestingly, the use of ginger and vitamin B6 is also found to be effective.

#gastroenterology
#Ob-gyn


Reference:

Flake ZA, Scalley RD, Bailey AG. Practical selection of antiemetics. Am Fam Physician 2004; 69:1169.