Contents
Morning sickness, also called nausea and vomiting of pregnancy (NVP), is a symptom of pregnancy that involves nausea or vomiting.
- M/C symptom of pregnancy (50–85% cases)
- Despite the name, can occur at any time during the day
- Typically occur between the 4th and 16th week of pregnancy
A dark history
Thalidomide was originally developed and prescribed as a cure for morning sickness in West Germany, but its use was discontinued when it was found to cause birth defects. The United States Food and Drug Administration (F&D) never approved thalidomide for use as a cure for morning sickness.
Pathophysiology
Diagnosis
Tools used to measure the severity of NVP:
| Tool | Description |
|---|---|
| PUQE score | Three questions regarding nausea, vomiting and retching during previous 12 hours (PUQE-24 = previous 24 hours) For each component: 0 = no symptoms, 5 = worst possible symptoms Maximum score = 15 Scores of ≥ 13 indicate severe symptoms |
| RINVR | Contains total of eight questions about duration/amount, frequency and distress caused by symptoms of nausea, vomiting and retching For each component: 0 = no symptoms, 5 = worst possible symptoms Maximum score = 40 Scores of ≥ 33 indicated severe symptoms |
| McGill Nausea Questionnaire (measures nausea only) | Contains a nausea rating index (nine sets of words which describe sensory, affective, evaluative and miscellaneous afferent feelings related to nausea that patients rank) An overall nausea index (0–5, where 0 = no symptoms, 5 = excruciating symptoms) Plus a VAS: 0 cm = no nausea, 10 cm = extreme nausea |
| NVPI | Three questions relating to nausea, retching and vomiting over the past 7 days For each component: 0 = no symptoms, 5 = worst possible symptoms Maximum score = 15 A score of ≥ 8 indicates severe symptoms |
| VAS | Patients rate their symptoms on a scale of 0–10, where 0 = no symptoms, 10 = extreme symptoms |
NVPI, Nausea and Vomiting of Pregnancy Instrument; PUQE, Pregnancy-Unique Quantification of Emesis and Nausea; RINVR, Rhodes Index of Nausea, Vomiting and Retching; VAS, visual analogue scale.
Differential diagnosis
Common causes:
- Cholecystitis
- Gastroenteritis
- Gastroesophageal reflux
- Migraine headaches
Less common causes:
- Biliary tract disease
- Drug toxicities or intolerances
- Hepatitis
- Hyperthyroidism
- Kidney stones
- Molar pregnancy
- Pancreatitis
- Peptic ulcer disease
- Preeclampsia/HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)
- Pyelonephritis
Uncommon causes:
- Acute fatty liver of pregnancy
- Addison disease
- Appendicitis
- CNS tumours
- Degenerating uterine leiomyoma
- Diabetic ketoacidosis (DKA)
- Hypercalcemia
- Intestinal obstruction
- Meniere disease
- Ovarian torsion
- Porphyria
- Pseudotumor cerebri
- Uremia
- Vestibular lesions
Management
