Prevalence of hyperemesis gravidarum using the 24-hour pregnancy unique quantification of emesis scale scoring-a descriptive study


  • Santosh Kumar Jha Department of Obstetrics and Gynaecology, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal
  • Veena Rani Shrivastava Department of Obstetrics and Gynaecology, Kathmandu Medical College Public Limited, Sinamangal, Kathmandu, Nepal



Antiemetics, HG, NVP


Background: Nausea and vomiting occur in 80% of all pregnancies that do not require treatment however; hyperemesis gravidarum (HG), a potentially life-threatening condition affecting 0.3% to 2% of pregnancies, which is characterized by protracted vomiting, retching, severe dehydration, and weight loss (>5% of pre-pregnancy weight) require hospitalization.

Methods: This was a hospital based cross-sectional descriptive study done at Kathmandu medical college over duration of 18 months from 1st January 2018 to 30th June 2019. Pregnant women ≤22nd weeks of gestation admitted with nausea and vomiting were taken as study group. Data collection was done with the questionnaire (modified 24 hours pregnancy unique quantification of emesis (PUQE) scoring system) on a structured proforma covering the relevant subjects of the study. Data were analyzed comparing difference in percentages of categorical variables chi-square test.

Results: Hundred and forty-nine women were enrolled in this study with nausea vomiting in pregnancy (NVP) among 692 patients of all obstetric admission within 22 weeks of pregnancy. The prevalence of NVP during the study period was 21.67%. Most of the women in the study group belonged to age group of 20-30 years. Only 12% of cases admitted with severe NVP. Mean duration of hospital stay was found to be 2.95±1.86 days. The incidence of the disease was maximum between 7-9 weeks of gestation.

Conclusions: There was no significant relation seen in severity of NVP and age, gravidity, education, occupation and BMI of women. Treatment with regular hydration and antiemetic had favourable outcome with early recovery.


Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL et al. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PloS One. 2015;10(4).

Lee NM, Saha S. Nausea and vomiting of pregnancy. Gastroenterol clin N. 2011;40(2):309-34.

Castillo MJ, Phillippi JC. Hyperemesis gravidarum: a holistic overview and approach to clinical assessment and management. J Perinat Neonat Nur. 2015;29(1):12-22.

Giri A, Tuladhar AS, Tuladhar H. Hyperemesis gravidarum and obstetric outcome. Nepal J Obstet Gynecol. 2012;6(2):24-6.

Colvin L, Gill A, Slack-Smith L, Stanley F, Bower C. Off-Label Use of Ondansetron in Pregnancy in Western Australia. Biomed Res Int. 2013;2013:1-8.

Ebrahimi N, Maltepe C, Bournissen F, Koren G. Nausea and Vomiting of Pregnancy: Using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) Scale. J Obstet Gynaecol Can. 2009;31(9):803-7.

Maina A, Todros T. A novel approach to hyperemesis gravidarum: evaluation by a visual analogue scale score and treatment with transdermal clonidine. Obstet Med. 2011;4(4):156-9.

Heitmann K, Nordeng H, Havnen GC, Solheimsnes A, Holst L. The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again–results from a cross-sectional study. BMC Pregnancy Childbirth. 2017;17(1):75-87.

Lacasse A, Rey E, Ferreira E, Morin C, Berard A. Nausea and vomiting of pregnancy: what about quality of life? BJOG. 2008;115(12):1484-93.

Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. J Perinatol. 2011;31(1):10-20.

Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Women Health. 2010;2:241-8.

Madjunkova S, Maltepe C, Koren G. The delayed-release combination of doxylamine and pyridoxine (Diclegis®/Diclectin®) for the treatment of nausea and vomiting of pregnancy. Pediatric Drugs. 2014;16(3):199-211.

Niebyl JR. Nausea and vomiting in pregnancy. N Engl J Med. 2010;363(16):1544-50.

Chhetry M, Thakur A, Uprety DK, Basnet P, Joshi R. Hyperemesis Gravidarum in a Tertiary Care Centre in Eastern Nepal: A Prospective Observational Study. J Ayub Med Coll. 2016;28(1):18-21.

Fazari AB, Ahmed HZ, Eltayeb R, Ali MH, Elmusharaf K. Management and outcome of hyperemesis gravidarum at tertiary obstetric facility, Khartoum-Sudan. J Obstet Gynecol. 2016;6(11):630-6.

Konikoff T, Avraham T, Ophir E, Bornstein J. Hyperemesis gravidarum in northern Israel: a retrospective epidemiological study. Isr J Health Policy Res. 2016;5(1):39.

Kramer J, Bowen A, Stewart N, Muhajarine N. Nausea and vomiting of pregnancy: prevalence, severity and relation to psychosocial health. Am J Matern Chil. 2013;38(1):21-7.

Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006;107(2):285-92.

Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R et al. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol. 2008;141(1):13-7.

Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006;107(2):277-84.

Poursharif B, Korst LM, MacGibbon KW, Fejzo MS, Romero R, Goodwin TM. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception. 2007;76(6):451-5.






Original Research Articles