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Early stage of pregnancy. Severe morning sickness. Noted red spots. Treatment?

I am early in my preg between 7 and 11 weeks and I am having severe morning sickness. I am not eating (maybe less than 400 calories a day) so when I start to vomit it usually is harsh dry heaving and maybe some saliva. Today I saw a few spots of red in my violent dry heaving spell in the toilet. I don't want to call my Dr bc they will just say got to ER as they suggested when I was throwing up everything last week but I chose not to go.
Mon, 22 Apr 2013
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OBGYN 's  Response
Dear nnewson0899,
Approximately 75% of pregnant ladies experience some sort of nausea and vomiting with pregnancy, neglection of these symptoms and the delay in management may result in progression to the more severe form named hyperemesis gravidarum in 2% of cases.
Before embarking on treatment, we should exclude other causes of vomiting such as gastrointestinal (appendicitis, gastritis, hepatitis, peptic ulcer, pancreatitis and biliary disease), genitourinary ( stones, pyelonephritis, ovarian tortion), metabolic disorders (diabetic ketoacidosis, hyperthyroidism) and neurological conditions (psychological conditions, migraines, brain tumors, drug toxicity and intolerance).
In addition to evaluation of symptoms (frequency of vomiting, weight loss, associated symptoms), there are some laboratory investigations to be done in order to assess severity and determine wether to be treated at home or at hospital (complete blood count, urine analysis and culture, ketone bodies in urine, serum electrolytes, serum creatinine, hepatic transaminases, and serology for hepatitis A,B and C).
Comming to treatment, start by increasing the duration of rest and avoid food or odors that trigger vomiting (perfumes, smoke, petroleum products).
- Adjust your eating habits: small frequent meals with focus on bland and dry foods and foods high in protein). Avoid fatty, acidic and spicy foods.
- Vitamine B6 10-25 mg plus doxylamine 12.5 mg orally every 8 hours.
- meclizine 25 mg every 6 hours.
- metro loperamide 10 mg every 8 hours.
- ondansetron 4-8 mg every 8 hours.
- severe cases require hospitalization, rest, nothing per os and parenteral fluids, cases may need intensive care for a while.
You do not have to worry from the blood, which is common in such cases and it will stop as soon as you recover.
I hope these words were usefull to you and I wish you speedy recovery and a peaceful pregnancy.
Dr. Ahmed Bahaa.
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