Female Reproductive System ORGAN SYSTEMS

Nausea and vomiting in pregnancy (NVP)

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
Clinical presentation of nausea and vomiting in pregnancy | Ufo Themes. (2019) Nausea, Vomiting, and Reflux | Obgyn Key. Retrieved April 15, 2019, from

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 of vomiting in pregnancy | Iam Ramsden, Robin Callandar- Public Domain,


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



Treatments for NVP. a, Care may also involve urine ± blood tests, weight and maternal observations; and b, care will involve urine and blood tests, weight, maternal observations and pelvic ultrasound. i.m., intramuscular. | O’Donnell A, McParlin C, Robson SC, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Southampton (UK): NIHR Journals Library; 2016 Oct. (Health Technology Assessment, No. 20.74.) Chapter 1, Introduction and background. Available from:

Leave a Reply