Diagnosis & Assessment

At every visit between 4 and 16 weeks, it's important to inquire about a patient’s experiences of nausea and vomiting, assessing severity using tools like the PUQE-24 score, along with weight and hydration status. Refer to the complete SOMANZ Guidelines for detailed recommendations on further investigations. Given the prevalence of NVP, all maternity-focused caregivers should be prepared to support women with mild to moderate symptoms (a PUQE-24 score of 12 or less).

Given that many women expect to be unwell in the first trimester, they may turn to their local pharmacist for advice rather than speaking to their doctor or midwife about it. For this reason, pharmacists and their staff are a vital source of support of information for women. 

For severe NVP or HG (a PUQE-24 score of 13 or above), specialised care is essential. Clinicians experienced in managing these conditions should lead assessment and treatment. If such specialists are unavailable, consider referral or telemedicine consultation. Contact us for information on available specialists.

Regardless of the caregiver or setting, clear and documented management plans are crucial. This ensures both the patient and other providers understand the condition, treatment options, and arrangements for ongoing care.

For comprehensive guidance on caring for women with NVP or HG, consult the full SOMANZ Guidelines.

As with most chronic illnesses, there is a spectrum of symptoms that may or may not be present in someone suffering from NVP or HG. Symptoms usually begin in the first trimester at about 6-8 weeks gestation, typically peaking at about 9 weeks and settling about 14 weeks for NVP; HG commonly persists until 21 weeks and for some, it will continue throughout the pregnancy until delivery. Most commonly sufferers will be experiencing one or more of these as a result of the nausea and/or vomiting:

  • Loss of 5% (or more) of pre-pregnancy weight

  • Dehydration

  • Constipation

  • Nutritional disorders, such as vitamin B1 (thiamine) deficiency, vitamin B6 (pyridoxine) deficiency or vitamin B12 (cobalamin) deficiency

  • Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis

  • Headaches or migraines

  • Aversions to food (including the sight or smell)

  • Excessive salivation

  • Exhaustion

  • Low blood pressure

  • Disorientation

  • Dizziness

  • Raised pulse

Symptoms

The Society of Obstetric Medicine of Australia and New Zealand’s Guideline for the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum recommends using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) test over 24 hours. The resulting score will determine whether an individual’s condition is mild, moderate or severe and will inform the course of treatment that is appropriate. You can download a printable version of the PUQE-24 questionnaire below.

Diagnosis

For more information on why we stand behind the Ditch the Ketones campaign run by Pregnancy Sickness Support, read the full outline here. We also recommend reading the American Journal of Obstetrics and Gynaecology review of ketone use here.

Ketone analysis has historically been used as a diagnostic criteria and threshold for treatment for HG. Recent systematic reviews have shown the presence of ketones has no correlation to the severity of symptoms and is not an indicator of dehydration. Additionally, some pregnant women will have ketones present in their urine throughout pregnancy even when their carbohydrate intake is sufficient. Therefore, in addition to a lack of ketones being a barrier to treatment, ketosis has sometimes been a barrier to discharge in women who have been well enough to go home from the hospital. Based on the best available evidence we do not recommend the use of keto analysis in assessing women with pregnancy sickness or hyperemesis gravidarum.