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Nausea and vomiting in pregnancy (RCOG, 2024)

16th September 2024 by Dr Louise Hudman

Nausea and vomiting in pregnancy (RCOG, 2024)

This is an updated guideline from RCOG on assessing and managing patients with nausea and vomiting in pregnancy. It was published in Feb 2024.

What is new for GPs in this guideline?

There were a few things in this that were new for me. I have outlined these here, but there is more explanation in the main body of the blog.

  • As well as the PUQE questionnaire, we can use the HELP (HyperEmesis Level Prediction) tool. It can be used to monitor treatment response in patients with severe nausea and vomiting as well as hyperemesis (which the PUQE can’t be). I have added more details on this below.
  • Doxylamine/pyridoxine (Xonvea) is a first line treatment option. This isn’t a drug I had come across before.
  • Ondansetron can be used as a 2nd line treatment. There is a very small increased risk of cleft palette if used in the first trimester.
  • Do not advise that women try ginger for severe symptoms. For mild to moderate symptoms some guidelines still suggest that ginger can be advised.
  • Many women who need secondary care input can be managed in an ambulatory setting.
  • In future pregnancies, early use of medication and lifestyle modification is advised, even before any symptoms start.
  • We should consider thiamine supplementation in those with severely reduced dietary intake.
  • Appendix V has a fantastic 2-page summary that we can use in general practice. It outlines the history and examination to make sure we don’t miss other causes. It advises on the investigations to do, summarises the PUQE questionnaire and gives a management flow chart, including all the drugs and their doses. Definitely worth having this saved somewhere.
  • There is also a really good patient leaflet from RCOG that summarises all the advice too, including about the medications used.

The RCOG summary of management

I thought it best to start with the flowchart of management. This really does outline everything very clearly in such a brilliant summary, that I can’t possibly better it. I will add a few bits afterwards with a bit of clarification here and there.

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