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nauseaJune 29 2016

New guidance for healthcare professionals to support pregnant women experiencing nausea and vomiting and hyperemesis gravidum have been published.

The Royal College of Obstetricians and Gynaecologists’ guidance sets out the diagnosis, severity and classification of nausea and vomiting in pregnancy (NVP), clinical assessment, management including antiemetics, monitoring, adverse effects, and follow up. It also considers aspects including the effect of NVP and hyperemesis gravidum on the mother’s quality of life and in the post-natal period.

‘Morning sickness’ affects up to 80% of pregnant women and is one of the most common reasons for pregnant women to be admitted to hospital. The more severe form, hyperemesis gravidum, affects 1-3% of pregnant women, and may be associated with a weight loss of more than 5% of pre-pregnancy weight, said the RCOG.

Its new ‘Green-top Guideline’ is the first national guideline to cover the condition. “The aim of this guideline is to provide evidence-based or best clinical practice information regarding the diagnosis and subsequent management of NVP and hyperemesis gravidum across community, ambulatory daycare and inpatient settings,” said the RCOG.

“It gives advice for multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies.” The guidance includes evidence, including a Cochrane review, which has reported on the safety and efficacy of the various drugs used for treating these conditions. It also makes recommendations about complementary remedies, including analysis of the usefulness of ginger, acupressure and hypnotherapy.

Professor Alan Cameron, RCOG Vice President, Clinical Quality, commented: “This is the first edition of this guideline on this important topic, which affects many women at a crucial time in their lives. Women suffering severely may need input from a multi-disciplinary team including midwives, nurses, dieticians and a mental health team. This will ensure they receive the best possible care and support.”

A information leaflet for women about pregnancy sickness has also been published covering:

  • what nausea and vomiting of pregnancy is and what hyperemesis gravidarum is
  • how it feels to have pregnancy sickness
  • what it means for the baby
  • what women can do to help if they have pregnancy sickness
  • when to seek medical help and what will happen if you do
  • anti-emetic medications

The RCGP issued a statement saying that the national media had picked up on the RCOG announcement but had focused on GPs. However, “the RCOG has made it clear that this applies to the multi-disciplinary team and healthcare professionals in general. Despite this, some national newspapers have focused on GPs specifically,” said the RCGP.

“‘Morning sickness’ can have a severe impact on a woman’s wellbeing, so while it is important our patients are given the care they need during this stage of pregnancy, this falls on a range of healthcare professionals, not just GPs.”

Links:

RCOG announcement

RCOG: ‘The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum’ (Green-top Guideline No.69)

RCOG patient information on pregnancy sickness

RCGP comment

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