PRACTICE UPDATE
JACQUI ANDERSON MIDWIFERY ADVISOR
nausea and vomiting in pregnancy: it’s enough to make you sick Nausea and vomiting during pregnancy (NVP)
women and requires referral for a management
and Nausea) scoring index
is one of the most common pregnancy-related
plan, including ascertaining physiological
(Ebrahimi et al., 2009)
conditions that midwives support women
and psychological wellbeing and the need
(see p.28). This tool can
through. NVP has been shown to greatly impact
for rehydration and antiemetics. Signs of
be used to assist the
a woman’s life, negatively affecting daily
dehydration include: decreased skin turgor; dry
diagnosis of HG, but
activities, relationship with partner, parenting,
mucous membranes; decreased urine output;
can also help midwives
occupation and social functioning. Women have
concentrated urine and postural drop in blood
and women gauge
also identified feeling isolated, deeply tired,
pressure. The most commonly cited criteria for
the degree of their
depressed, and a sense of helplessness due to
diagnosis of HG include: persistent vomiting with
particular experience.
nausea (Heitmann et al., 2015; Lowe et al., 2020;
weight loss not related to other causes, along
Tan, Lowe & Henry, 2017).
with an objective measure of acute starvation
a mild score may
While women with
such as carbohydrate depletion, electrolyte
not require medical
experience nausea during pregnancy and 50%
abnormalities and/or acid-base disturbance
management, they
experience both nausea and vomiting (Heitmann
(London, Grube & Sherer, 2017).
still need support and
Approximately seven out of 10 women
et al., 2015). NVP is generally defined as
Women with diabetes or other pre-existing
symptoms of nausea, vomiting and/or
conditions (e.g. epilepsy, thyroid disease) who
dry-retching, commencing in the first trimester
may be adversely affected by nausea
of pregnancy without any pathophysiological cause (Lowe et al., 2020). For most women, symptoms appear around
and vomiting, especially in relation to timing and absorption of medications, need early support to manage NVP. Women with diabetes
affirmation that this will eventually improve, and to be given strategies to try and manage their symptoms. Acknowledgement that NVP is wearying and very
the sixth week of pregnancy, often peaking
need to be monitored carefully, as dehydration
around 8–12 weeks and gradually resolving
increases the risk of diabetic ketoacidosis, along
by about 16-20 weeks. Approximately 10% of
with the usual effects of early pregnancy on
women will still experience symptoms after
blood sugar stability.
MANAGING NVP
ASSESSMENT OF THE DEGREE OF NVP
A 2015 Cochrane systematic review
20–22 weeks of pregnancy (London, Grube & Sherer, 2017). While persistent nausea and vomiting in early pregnancy can be particularly
Asking women to keep a diary of when they
debilitating for some women, it is not usually
are affected by nausea and/or vomiting can
associated with any adverse pregnancy
help to identify the degree to which they are
outcomes. However, because NVP is viewed as
affected and the potential for dehydration. This
a normal and expected part of pregnancy, some
can also help women to identify triggers and
women tolerate significant symptoms, both
therefore consider ways to avoid or mitigate
physical and psychological (Lowe et al., 2020;
these where possible.
Tan, Lowe & Henry, 2017). The most severe form of NVP, hyperemesis gravidarum (HG), affects about 1% of pregnant
28 | AOTEAROA NEW ZEALAND MIDWIFE
One validated assessment tool used to try
unpleasant can be supportive for women and their families.
identified that there is insufficient strong evidence to support any one treatment or management regime (Matthews et al., 2015). There is limited evidence from clinical trials about the effectiveness of dietary and lifestyle interventions, but it is generally agreed that making adjustments in these areas should be the initial approach to managing NVP.
to determine the severity of NVP is the PUQE (Pregnancy Unique Quantification of Emesis
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