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22/06/2016

RCOG Releases New Guidance On Hyperemesis Gravidarum

New guidance in relation to support for women affected by nausea and vomiting in pregnancy and hyperemesis gravidarum have been published at the Royal College of Obstetricians and Gynaecologists (RCOG) World Congress in Birmingham.

Better known as morning sickness, nausea and vomiting in pregnancy affects up to 80% of women and is one of the most common reasons for pregnant women being admitted to hospital. Clinically, it is defined as the symptom of nausea and/or vomiting during early pregnancy where there are no other causes.

A more severe form of nausea and vomiting in pregnancy is hyperemesis gravidarum. It is much rarer and affects around 1 to 3% of pregnant women. It is characterised by severe, protracted nausea and vomiting associated with weight loss of more than 5% of pre-pregnancy weight, fluid loss or dehydration.

For most women, their symptoms of nausea and vomiting in pregnancy or hyperemesis gravidarum improve or disappear by around week 14.

This Green-top Guideline is the first national guideline to cover the subject and looks at the management of nausea and vomiting of pregnancy and hyperemesis gravidarum, providing healthcare professionals with guidance on diagnosis, as well as monitoring the severity of the condition, and the treatment and effects of the condition, particularly on mental health and follow-up care.

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Medications used specifically to treat nausea and vomiting in pregnancy and hyperemesis gravidarum are discussed in the guidance, with evidence reporting on the safety and efficacy of the various drugs used for treating these conditions. Complementary therapies are also addressed, including the usefulness of ginger, acupressure and hypnotherapy.

The report acknowledges the effect nausea and vomiting in pregnancy and hyperemesis gravidarum can have on quality of life of a woman, and suggests that clinicians should consider this effect on a woman's mental health during pregnancy and postnatally, and – if needed – refer her for support, such as counselling.

Dr Manjeet Shehmar, Consultant Obstetrician and Gynaecologist and lead author of the guideline, said: "Women suffering from nausea and vomiting and hyperemesis gravidarum can face a challenging time in early pregnancy. The more severe the condition, the more it can affect their day-to-day quality of life and mental health.

"Women with persistent nausea can often feel that there is a lack of understanding of their condition, they may be unable to eat healthily, have to take time off work and feel a sense of grief for loss for what they perceive to be a normal pregnancy.

"It is therefore vital that women with this condition are given the right information and support and are made aware of the therapeutic and alternative therapies available to help them cope. Women should be encouraged to rest as much as they can as this has been shown to relieve symptoms."

Professor Alan Cameron, RCOG Vice President, Clinical Quality, added: "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."

(JP)

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"New guidance in relation to support for women affected by nausea and vomiting in pregnancy and hyperemesis gravidarum have been published at the Royal College of Obstetricians and Gynaecologists (RCO