Fifth-Line Pharmacotherapy for Late Vomiting of Pregnancy

Late vomiting of pregnancy (ICD-11 JA60.2 / ICD-10 O21.2) describes persistent or severe nausea and vomiting arising in the later stages of pregnancy. When earlier treatments do not provide adequate control, a fifth-line pharmacotherapy step is indicated.

Clinical Situation

This protocol applies at the fifth-line stage — reached when antiemetic medications and intravenous hydration have already been trialled and found insufficient to control symptoms.

Treatment Approach (partial overview)

Fifth-line management involves pharmacotherapy with corticosteroids, applied in a structured manner guided by clinical response and tolerability.

The complete regimen — including sequencing, dosing, and alternative agents — is set out in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

Steroids should only be used if antiemetic medications and IV hydration have failed.
100 mg IV twice daily followed by oral steroid once tolerated.
10 mg orally tds increasing to 15 mg tds after 48 hours if required. Wean by 5 mg per week unless symptoms recur.

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