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024 7638 2020

Healthcare Professionals

HG Facts

Hyperemesis Gravidarum rarely ends at 12 weeks of pregnancy. It typically improves in the middle of pregnancy, but symptoms often last until birth. 

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Management

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Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum are particularly challenging conditions for healthcare professionals to manage, particularly in community settings and when mothers already have young children to care for. Here we hope to give you some suggestions for how to help women with NVP and HG, in particular the information is aimed at General Practitioners in a community setting. If you are a midwife please see our Information for Midwives as well.

Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum can be particularly isolating for women experiencing them; in first pregnancies it is usually a complete shock to find themselves feeling so ill and it is important that Healthcare professionals take them seriously so that they can feel understood and that the condition is a valid one [1].

Complete a thorough assessment of the symptom severity using our check-list for GPs and Midwives:

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?

Tip: Download 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
    significant
  • 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
    confusion.[4]
  • is there any ketonuria or weight loss >5% of pre-pregnancy weight despite oral anti-emetics? [2]

Criteria for referral to secondary care [2]

  • Continued nausea and vomiting associated with ketonuria OR 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.

The above check-list was produced by Dr Roger Gadsby FRCGP MBE & Dr Tony Barnie-Adshead FRCGP trustees of Pregnancy Sickness Support Trust. Click here to download a printable copy of the above checklist.

 

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.

References

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
p.59