Evidence-Based Approaches to Managing Nausea and Vomiting in Early Pregnancy

Tekoa L. King, CNM, MPH; Patricia Aikins Murphy, CNM, DrPH

Disclosures

J Midwifery Womens Health. 2009;54(6):430-444. 

In This Article

Assessment: The Pregnancy Unique Quantification of Emesis/Nausea Score

Most clinicians attempt to manage the early symptoms of NVP in order to prevent progression to severe symptoms. Given the subjective nature of conditions such as nausea, retching, and vomiting, consistency of the assessment is critical. The Rhodes Index[22,23] is an objective, validated measure used to grade the severity of nausea and vomiting and to follow the course of the condition. It has been revised to measure nausea, vomiting, and retching.[22] This scoring system, originally used to assess nausea and vomiting in chemotherapy patients, quantifies physical symptoms and the resulting stress and psychological symptoms. Although the tool has been used in many research studies of NVP treatments, it is detailed, time-consuming, and cumbersome for use in assessing women in a clinical setting. A shorter assessment guide was developed by clinicians and researchers from the Motherisk NVP helpline in Canada to streamline assessment and correct some of the problems associated with use of the Rhodes Index. The Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) Index (Figure 1) is based on only three questions, is highly correlated with scores on the Rhodes Index, and has been validated in clinical use.[24,25]

Figure 1.

Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) index. Total score is sum of replies to each of the three questions. Nausea Score: Mild NVP = ≤6; Moderate NVP = 7–12; Severe NVP = ≥13. Reprinted with permission from Koren G et al.[24]

The original PUQE Index focused on symptoms experienced during the previous 12 hours—and was later modified to 24 hours[26]—reflecting the appropriate time frames to judge the efficacy of therapy for hospitalized women or those provided with frequent evaluation and follow-up. The index was recently modified to address symptoms of NVP over a longer period of time (Figure 2).[27]

Figure 2.

Modified Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) index. Total score is sum of replies to each of the three questions. Nausea Score: Mild NVP = ≤6; Moderate NVP = 7–12; Severe NVP = ≥13. Reprinted with permission from Lacasse A et al.[27]

The PUQE Index score can be used to determine if the NVP is mild, moderate, or severe. If the score is moderate or severe (score of ≥7), a thorough assessment includes any changes in weight, the presence or absence of dehydration, and lab indices to check for electrolyte imbalances. Finally, if the initial onset of nausea and vomiting occurs after 10 weeks' gestation, the etiology is not likely to be NVP, and other causes need to be considered.

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