MDCalc

Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) Score

Assesses the severity of nausea and vomiting in pregnancy (NVP).

Please select the response that best reflects the patient’s answer:

In the last 12 hours, for how long have you felt nauseated or sick to your stomach?

In the last 12 hours, have you vomited or thrown up?

In the last 12 hours, how many times have you had retching or dry heaves without bringing anything up?

Result:

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Advice
  • Use results alongside a full clinical assessment; management decisions should balance symptom severity, the patient’s desire for treatment, and the potential maternal and fetal effects of treatment.
  • Repeat assessments can help monitor treatment response and support decisions to escalate or deescalate therapy. 
    • Valid for mild or moderate symptoms only; serial results are not valid for severe symptoms/hyperemesis gravidarum.
    • A clinically significant change is generally considered a change of 1–2 points or more.
  • A high score (≥13) should prompt an evaluation and management for dehydration, electrolyte abnormalities, and nutritional deficiency.
Management

Management recommendations are not explicitly delineated by severity; clinical decisions should be based on a comprehensive assessment, but general principles include:

  • Treatment setting:
    • Milder symptoms may be appropriately managed in the outpatient setting with close follow-up.
    • Inpatient management may be required for: 
      • Severe or refractory symptoms.
      • Clinical dehydration.
      • Certain comorbidities in which inability to tolerate oral intake could cause complications.
      • Evidence of organ dysfunction.
  • Non-pharmacologic measures:
    • Dietary modifications (e.g., smaller, more frequent meals, avoidance of spicy foods).
    • Rest.
    • Avoidance of triggering sensory stimuli (e.g., odors, heat).
    • Ginger.
  • Pharmacologic therapies:
    • First-line: Vitamin B6 with or without doxylamine.
    • Oral antiemetics may be appropriate for patients able to tolerate oral intake:
      • Initial options often include antihistamines, phenothiazines.
      • Subsequent options include ondansetron and metoclopramide.
    • Parenteral, transdermal, or rectal forms and combination therapy may be necessary for persistent or severe symptoms.
    • A short course of intravenous corticosteroids is considered last-line for severe, refractory symptoms.

For more detailed management recommendations, please refer to local society guidelines, such as:

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