The management of nausea and vomiting during pregnancy

- Appendix

Appendix-1

Differential Diagnosis of Nausea and Vomiting of Pregnancy:

Gastrointestinal conditions:

·        Gastroenteritis

·        Gastroparesis

·        Achalasia

·        Biliary tract disease

·        Hepatitis

·        Intestinal obstruction

·        Peptic ulcer disease

·        Pancreatitis

·        Appendicitis

Conditions of the genitourinary tract:

·        Pyelonephritis

·        Uremia

·        Ovarian torsion

·        Kidney stones

·        Degenerating uterine leiomyoma

Metabolic conditions:

·        Diabetic ketoacidosis

·        Porphyria

·        Addison’s disease

·        Hyperthyroidism

·        Hyperparathyroidism

Neurologic disorders:

·        Pseudotumor cerebri

·        Vestibular lesions

·        Migraine headaches

·        Tumors of the central nervous system

·        Lymphocytic hypophysitis

Miscellaneous conditions:

·        Drug toxicity or intolerance

·        Psychologic conditions

Pregnancy-related conditions:

·        Acute fatty liver of pregnancy

·        Preeclampsia

Quoted from: Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists, Number 189, January 2018. Reprinted from Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008;35:401–17, viii, with permission from Elsevier.

 

Appendix-2

Pregnancy Unique-Quantification of Emesis (PUQE) score

 

	1 point	2 points	3 points	4 points	5 points
Duration of nausea in the past 12 hours	0	≤1 hour	2 to 3 hours	4 to 6 hours	>6 hours
Number of vomiting episodes in the past 12 hours	0	1 to 2	3 to 4	5 to 6	≥7
Number of episodes of dry heaves in the past 12 hours	0	1 to 2	3 to 4	5 to 6	≥7

Total score 4 to 6: mild nausea and vomiting of pregnancy. Total score 7 to 12: moderate nausea and vomiting of pregnancy. Total score ≥13: severe nausea and vomiting of pregnancy.

Adapted from:

1.   Koren G, Boskovic R, Hard M, et al. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002; 186:S228.

2.   Koren G, Piwko C, Ahn E, et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J Obstet Gynaecol 2005; 25:241.