Nausea & Vomiting of Pregnancy ED Protocol
1.) Confirm IUP
2.) Obtain BMP & U/A
3.) Lack of ketones suggest alternative
diagnosis
Intravenous fluid replacement with D5LR 1L bolus,
8mg IV Ondansetron, replete K+ prn
Wait 45 min-1 hour
an
1st POover
Challenge
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

If fails first PO challenge administer: Phenergan 12.5-25 mg IV
or25mg PR
Wait 45 min- 1 hour after 2nd antiemetic administered  2nd PO Challenge
If fails second PO challenge after receiving 2 antiemetics, consult Ob/Gyn for
possible admission
**Severe abdominal pain suggests another diagnosis
**IV narcotics should be avoided in pregnancy whenever possible**
**Call OBGYN to schedule f/u visit in the next 7-10 days
Appropriate interventions at discharge:
1.)
2.)
3.)
4.)
5.)
6.)
25mg pyridoxine PO q8 hours
10mg doxylamine PO q8 hours
4mg Zofran ODT 1-2 tabs PO 6-8 hours prn
25mg Phenergan PR q12hrs PRN
Consider use of acupressure (Sea Bands to wrists)
Consider use of over the counter ginger products