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Assessment of the symptom severity using our check-list for GPs and Midwives

Because morning sickness is considered a normal and healthy part of pregnancy most women expect to get it and some even report to us that they looked forward to it as a "life experience". So by the time many women present to their GP with NVP symptoms they are likely to have put up with a significant amount before seeking help. It is important that Healthcare professionals take them seriously so that they can feel understood and that the condition is a valid one [1].

The following assessment check-list was produced by Dr Roger Gadsby FRCGP MBE & Dr Tony Barnie-Adshead FRCGP trustees of Pregnancy Sickness Support Trust.

Background information from notes:

  • How many weeks pregnant is she?
  • How many previous pregnancies?
  • History of NVP Symptoms in previous pregnancy?

NB: Symptoms usually begin in the first trimester at about 6-8 weeks gestation, typically peaking at about 9 weeks and settling about 12 weeks; a minority of women have symptoms after 20 weeks [2]. Gestation means from LMP.

History Questions:

  • How many weeks from LMP did symptoms start?
  • How many episodes of nausea occur each day? NB. A large majority of pregnant
    have episodes of nausea before & after midday. Therefore the term morning
    sickness is a misleading name. A more appropriate name is episodic nausea &
    vomiting of pregnancy
  • For how many hours a day are you feeling nauseated?
  • Have you vomited?
  • How many times a day?
  • Have you lost weight compared to your weight before you became pregnant?

TipDownload this daily symptom diary for women to fill in, this will assist your assessment and help them find a pattern of nausea free moments in which to eat and drink.

Assess the effect of the symptoms:

  • Can you eat and drink properly?
  • How many times vomiting a day? NB. No. of vomits and quantity of fluids lost are
  • Have you lost weight more than 5% of weight before you became pregnant?
  • Is nausea affecting your normal lifestyle?
  • Is your ability to shop, cook or do housework affected?
  • Are your symptoms affecting your ability to do paid work?
  • Are you feeling depressed because of your symptoms of NVP? [3]
  • Offer anti-emetics to women in primary care in whom nausea & vomiting interferes
    with normal function.[2]

Prescribe Oral Anti-emetic Therapy if required [3]

  • Cyclizine 50mgs tablets one nocte increasing as needed to one tds should be the first choice and add Pyridoxine (vitamin B6) 10mgs tablets up to maximum of 4 tablets daily if needed. [3]

Tip: Refer women to our support network of emotional support too.

Assess for signs of Hyperemesis Gravidarum (HG):

  • is there any evidence of dehydration? NB. Symptoms & signs may include scanty
    dark infrequent urine, thirst,dry mouth,difficulty in swallowing ,red swollen tongue ,loss
    of skin elasticity ,loss of weight , low B.P., raised pulse rate ,lethargy or later
  • weight loss >5% of pre-pregnancy weight despite oral anti-emetics? [2]
  • Do not assess ketonuria; they are not associated with either dehydration or severity of hyperemesis [5]

Criteria for referral to secondary care [2]

  • Continued nausea and vomiting associated weight loss (greater
    than 5% of pre-pregnancy body weight) despite oral anti-emetics
  • Continued nausea and vomiting and inability to keep down oral anti-emetics
  • Confirmed or suspected co-morbidity (such as confirmed urinary tract infection and unable to tolerate oral antibiotics)

Tip: to find out which consultant to refer women in your area to or to contact one of our GP's for further information please go to our find a specialist page.


For further research and resources such as a fluid balance chart for women to complete at home please refer to our Resources section. Please also take the time to refer women to our support network.


1. MUNCH S. A Qualitative Analysis of Physician Humanism: Women's Experiences with Hyperemesis Gravidarum. Journal of Perinatology, 2000; 20 - 540-547

2. Jarvis S, Nelson-Piercy C Management of nausea and vomiting in pregnancy BMJ 2011 342: 1407-1412

3. Gadsby R Barnie-Adshead A Severe nausea and vomiting of pregnancy: should it be treated with appropriate pharmacotherapy 2011 The Obstetrician & Gynaecologist 13:107-111

4. Higgins C., Understanding Laboratory Investigation 2000 Blackwell Science Ltd. Oxford

5. Niemeijer MN, Grooten IJ, Vos N, Bais JMJ, van der Post JA, Mol BW, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am J Obstet Gynecol. 2012;211(2):150.e1-.e15.

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