I have experienced five episodes of vomiting and am uncertain whether I am pregnant; what should I do?

Immediate Assessment for Vomiting with Uncertain Pregnancy Status

You should immediately take a pregnancy test and assess for signs of dehydration, while carefully evaluating whether the vomiting is bilious (green), projectile, or associated with abdominal pain—as these characteristics determine urgency and next steps.

Critical First Steps

Confirm Pregnancy Status

• Obtain a urine or serum pregnancy test immediately to guide all subsequent management decisions 1
• A negative test does not definitively exclude early pregnancy if taken too soon after conception, but combined with timing of last menstrual period helps assess likelihood 1
• If your last normal menses was within 7 days, you have not had intercourse since your last menses, or you've been using reliable contraception consistently, pregnancy is less likely 1

Assess Vomiting Characteristics (Critical for Triage)

• Bilious (green/yellow) vomiting requires urgent evaluation as it suggests intestinal obstruction and is never normal 2, 3, 4
• Projectile vomiting (forceful expulsion across a distance) warrants thorough evaluation for serious conditions 3
• Non-bilious, non-projectile vomiting is more likely related to gastroenteritis, food intolerance, or early pregnancy 3, 4

Evaluate Hydration Status

• Check for signs of dehydration: decreased urination (fewer than 4 times in 24 hours), dry mouth, dizziness when standing, dark urine 3
• Moderate to severe dehydration may require IV fluids rather than oral rehydration 3

If Pregnancy Test is Positive

Early Pregnancy Considerations

• Nausea and vomiting affect 50-80% of pregnancies and typically begin around 4-6 weeks gestation 1
• Hyperemesis gravidarum (severe, persistent vomiting) occurs in severe cases and can cause liver test abnormalities and dehydration 1
• Measure liver enzymes if vomiting is severe or persistent, as 40-50% of hyperemesis cases show mild, self-limiting elevations 1

Red Flags Requiring Urgent Evaluation in Pregnancy

• Bilious vomiting (suggests obstruction) 2, 3
• Blood in vomit 3
• Severe abdominal pain (consider ectopic pregnancy, appendicitis) 1
• Fever with vomiting 4
• Signs of severe dehydration 1, 3

Management for Pregnancy-Related Vomiting

• Start with small, frequent meals and avoid triggers 1
• Ginger and vitamin B6 may provide symptomatic relief 1
• If unable to keep down fluids, seek medical attention for possible IV hydration and antiemetics 1
• Ondansetron or other antiemetics can be prescribed but should be discussed with your provider regarding safety in pregnancy 1, 3

If Pregnancy Test is Negative

Most Likely Causes

• Viral gastroenteritis is the most common cause of acute vomiting in otherwise healthy individuals 3, 4
• Food poisoning or intolerance 3
• Medication side effects 3
• Recent viral upper respiratory infection can trigger vomiting through nasal inflammation 4

Self-Management Approach

• Oral rehydration solution in small, frequent volumes (5 mL every minute initially using a spoon) 3
• Avoid solid foods initially; gradually reintroduce bland foods as tolerated 3
• Antiemetics are generally not necessary for routine viral gastroenteritis unless vomiting completely prevents oral intake 3, 4

When to Seek Immediate Medical Care

• Vomiting becomes bilious (green) or contains blood 2, 3, 4
• Severe abdominal pain or distension 3
• Signs of dehydration despite oral rehydration attempts 3
• Vomiting persists beyond 24-48 hours 3
• Fever above 101°F (38.3°C) with vomiting 4
• Inability to keep down any fluids for 12+ hours 3

Common Pitfalls to Avoid

• Do not assume vomiting is pregnancy-related without testing—other serious conditions can present similarly 1, 3
• Do not ignore bilious vomiting—this always requires urgent imaging evaluation regardless of pregnancy status 2, 3
• Do not delay seeking care if unable to maintain hydration—dehydration can progress rapidly with repeated vomiting 3
• Do not use anti-diarrheal or antimotility agents—these are ineffective and can cause serious side effects 3