NICE clinical guidance
NICE suggests non-pharmacological rehydration and conservative management as first line treatment of NVP1,2, for example:
- Rest
- Avoid any foods or smells that trigger symptoms (for example spicy or fatty foods)
- Eat plain biscuits or crackers in the morning before getting up
- Eat bland, small, frequent meals low in carbohydrate and fat but high in protein. Cold meals may be more easily tolerated if nausea is smell-related
- Drinking little and often rather than large amounts, as this may help to prevent vomiting
- Ginger
- P6 (wrist) acupressure
- Consider advising avoidance of iron-containing preparations if they make symptoms worse
Information on all self-help and non-pharmacological treatment options should be made available to women with NVP.
If symptoms persist pharmacological intervention with an anti-emetic should be considered2,3 and the 2016 RCOG Guidelines state that anti-emetics should be considered in all women with NVP, and recommends antihistamines as the first-line pharmacotherapy treatment option (please note that nearly all anti-emetics and antihistamines are not approved for use in NVP).2
NICE suggests that if an anti-emetic is required for NVP, prescribe an antihistamine, or a phenothiazine* (oral prochlorperazine), and reassess after 24 hours. If treatment response is good, continue treatment and review again after one week. If the response is inadequate, the woman is not dehydrated and there is no ketonuria, switch to another anti-emetic from a different class and reassess after 24 hours. If the response after the second anti-emetic is still inadequate, seek specialist advice and review the woman once a week thereafter.2
*Not licensed for NVP