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 .
The following assessment 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.
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 . Gestation means from LMP.
- 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
- 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? 
- Offer anti-emetics to women in primary care in whom nausea & vomiting interferes
with normal function.
Prescribe Oral Anti-emetic Therapy if required 
- 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. 
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
- is there any ketonuria or weight loss >5% of pre-pregnancy weight despite oral anti-emetics? 
Criteria for referral to secondary care 
- 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.
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