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Its safety in the first trimester has been established.38Small studies have shown comparable effectiveness between ondansetron (Zofran) and promethazine in treating nausea and vomiting, although patients receiving ondansetron had less sedation.39 Ondansetron is significantly more expensive than promethazine.The use of ondansetron in pregnancy has not been shown to increase the risk of miscarriage, major malformations, or low birth weight.40.A study involving 40 women found that methylprednisolone is superior to promethazine in reducing symptoms of nausea and vomiting in patients with hyperemesis gravidarum.44 However, a meta-analysis of four studies found that the use of glucocorticoids before 10 weeks' gestation is associated with a three- to fourfold increased risk of cleft lip.45 Therefore, glucocorticoids should be used only after 10 weeks' gestation..Fluid replacement is safe and effective in restoring volume and electrolytes in women who have hyperemesis gravidarum and are unable to tolerate oral intake.Women with higher h CG levels, such as those with multiple gestations, hydatidiform moles, or fetuses with Down syndrome, are at increased risk of nausea and vomiting.12Levels of estrogen and progesterone may also be involved.

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It is available as a rectal suppository and can be compounded as a topical agent that is applied to the wrist.No laboratory tests are necessary in patients with normal examination findings and no evidence of dehydration.If not already performed, ultrasonography may be used to evaluate for the presence of a molar pregnancy or multiple gestation if there is clinical suspicion or abnormally elevated h CG levels.Lactated Ringer solution or normal saline is acceptable.Because of the risk of Wernicke encephalopathy, intravenous thiamine should be added if dextrose-containing fluids are administered, if vomiting has lasted longer than three weeks, or if fluid replacement lasts longer than three days.46.

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