Some Causes of Nausea and Vomiting During Early Pregnancy
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Obstetric | ||
Nausea and vomiting of pregnancy | Mild, intermittent nausea and/or vomiting at varying times throughout the day, primarily during the 1st trimester Normal vital signs and physical examination | History and physical examination |
Frequent, persistent nausea and vomiting with inability to maintain adequate oral intake of fluids, food, or both Usually, signs of dehydration (eg, tachycardia, dry mouth, thirst), ketonuria, and weight loss > 5% of prepregnancy weight | If the condition is very severe or persistent, hydatidiform mole evaluation | |
Gestational trophoblastic disease (hydatidiform mole) | Larger-than-expected uterine size, absent fetal heart sounds and movement Sometimes, elevated blood pressure, vaginal bleeding If more advanced, generalized edema, grapelike tissue from the cervix | Blood pressure measurement, quantitative hCG, thyroid tests, creatinine, liver tests, chest x-ray, pelvic ultrasonography, D & C |
Nonobstetric | ||
Acute, not chronic vomiting; usually accompanied by diarrhea Normal (benign) abdomen (soft, nontender, usually not distended) | Physical examination Sometimes, stool testing | |
Acute nausea and vomiting, usually in patients who have had abdominal surgery (causing adhesions), have an intraabdominal malignancy, or sometimes an incarcerated hernia detected during examination Colicky pain, with obstipation and distended, tympanitic abdomen May be caused by or occur in patients with appendicitis | Abdominal imaging with flat and upright x-rays, ultrasonography, and possibly CT (if x-ray and ultrasound results are equivocal) | |
Urinary tract infection or pyelonephritis | Urinary frequency, urgency, or dysuria, with or without flank pain and fever | Urinalysis and culture |
D & C = dilation and curettage; hCG = | ||