Clinical Review Interactive case report

Treatment of nausea and vomiting during pregnancy: presentation

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7434.276 (Published 29 January 2004) Cite this as: BMJ 2004;328:276
  1. Nicola Harker, general practitioner1,
  2. Alan Montgomery, lecturer in primary care research2,
  3. Tom Fahey, professor of primary care medicine (t.p.fahey{at}dundee.ac.uk)3
  1. 1Dean Lane Family Practice, Bedminster, Bristol
  2. 2Division of Primary Health Care, University of Bristol
  3. 3Tayside Centre for General Practice, University of Dundee, Dundee DD2 4AD
  1. Correspondence to: T Fahey

    Ms Reynolds, a 25 year old woman, primiparous with one miscarriage, presented to her general practitioner when eight weeks pregnant complaining of nausea and vomiting. These symptoms were associated with a feeling of light headedness. Ms Reynolds had no relevant medical history and had not suffered from nausea and vomiting in her two previous pregnancies. Initially she was treated with prochlorperazine, which she took for five days, but this did not relieve her symptoms.

    She presented again two weeks later, still vomiting up to four times a day, with associated nausea and light headedness. Her blood pressure was 120/75 mm Hg sitting and standing, and urine analysis showed no abnormality.

    Ms Reynolds was happy to be pregnant and was living with her boyfriend. Her daughter was 5 years old and fit and well. They lived in a council owned flat with no specific social problems, but she commented that her symptoms were making it difficult for her to cope with looking after her daughter. Having tried prochlorperazine without success, she was reluctant to try further conventional drugs and asked about alternatives.



    Embedded Image

    The safety of all non-prescription medicines is an issue for pregnant women

    Credit: JOSH SHER/SPL

    Questions

    1. What would you say to the patient about the safety of treatments (both conventional and complementary) in pregnancy?

    2. What study design might provide evidence for their relative efficacy in an individual patient?

    3. How would you rate the relevance of such evidence to another patient?

    4. How many of your patients are using complementary therapies, and what percentage of pregnant women do you think use complementary therapies such as herbal treatments or supplements during pregnancy?

    Please respond through bmj.com

    Acknowledgments

    This is the first of a three part case report where we invite readers to take part in considering the diagnosis and management of a case using the rapid response feature on bmj.com Next week we will report the case progression and in five weeks' time we will report the outcome and summarise the responses

    We welcome contributions of interactive case reports. Cases should raise interesting clinical, investigative, diagnostic, and management issues but not be so rare that they appeal to only a minority of readers.

    Full details of criteria are available at: bmj.com/cgi/content/full/3267/7389/564/DC1

    Footnotes

    • Competing interests None declared.