Health Questions and Answers

Question: What is the differential diagnosis of nausea and vomiting in pregnancy NVP?

Answer:

In terms of obstetric conditions, several disease states have been associated with an increased risk of NVP, including multiple gestation, gestational trophoblastic disease, and fetal aneuploidy (triploidy and trisomy 21). If a patient presents with symptoms in the third trimester, acute fatty liver of pregnancy and preeclampsia must be ruled out. Outside of direct obstetric-related complications, the differential diagnosis is broad, and other medical disorders should be considered if vomiting persists, if symptoms begin later than 9 weeks’ gestation, or if symptoms acutely worsen.
Primary gastrointestinal disorders to consider are biliary tract disease, hepatitis, intestinal obstruction, peptic ulcer disease, pancreatitis, appendicitis, and gastroenteritis. Endocrine disorders include hyperthyroidism, diabetic ketoacidosis, and Addison disease. Genitourinary disorders include pyelonephritis, nephrolithiasis, ovarian torsion, and degeneration of uterine fibroids. Finally, the diagnosis of migraine headache and pseudotumor cerebri as well as primary CNS lesions may be entertained.

Reference: Creasy RK, Resnik R: Maternal Fetal Medicine, 4th ed. Philadelphia, WB Saunders, 1999, pp 122-131.

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