Planning an HG Pregnancy
None of the information provided by HGA is meant to suggest any medical course of action. Instead, the information is intended to inform so that these issues can be discussed with qualified Health Care Professionals. The responsibility for any medical treatment rests with the prescriber.
A printable copy of this resource, along with blank templates for preparing your own plan, is available at the end of this page.
Whether you suffer from HG or NVP in your first or fifth pregnancy there is a high chance of developing the sickness again in your next pregnancy. Now that you know what you’re in store for, it’s important to have a solid care plan in place before you start trying to conceive, or as soon as you find out you’re pregnant.
This resource has been prepared for you to take along to your GP or OB so that you can work together on your care plan. Your plan should include anything from your previous experience of HG or NVP that may be helpful this time - so remember to tell your provider about what worked, what didn’t work and anything else that might be useful.
Things to document in advance
Take your pre-pregnancy weight so that weight loss can be easily tracked
Discuss treatment options, and when you should start these. Make sure you’re clear on what to do if you feel worse or better on treatment. It can be helpful for your doctor to give you a prescription when you are planning to fall pregnant, so that you can start treatment as soon as needed once you are pregnant
Plan to see your doctor soon after you get pregnant if you have bad nausea or vomiting that isn’t responding to treatment [see below]
Remember to mention any medications you had a bad reaction to the first time
Discuss when you should go to the Emergency Room or maternity hospital and what would be the reasons for admission to hospital and who you should contact if you think this is needed
Discuss the possibility of regular drip fluids either in the maternity/outpatient ward or your GP’s surgery
Agree to and document treatment plan that you can keep with you and give to anyone else who may need it (eg. your partner, parents or friend)
Treatments
As a first step in a future pregnancy there is strong evidence for the use of pre-emptive medication if you start to feel nauseated:
One of the following taken orally up to three times daily:
Doxylamine 6.25-25mg
Prochlorperazine 5mg
Promethazine 25mg
Metoclopramide 10mg
PLUS Pyridoxine (vitamin B6, 10-50mg) orally four times a day
This combination is safe and effective for the treatment of nausea and vomiting in pregnancy. Starting this combination as soon as a positive pregnancy test is received can reduce the severity of symptoms dramatically. Waiting until you are vomiting to start this treatment can still work but pre-emptive treatment is recommended, where possible.
Once symptoms set in, and if the above combination is not enough to keep you well, the following can be added. All of these recommendations are in-line with the Society of Obstetric Medicine of Australia and New Zealand Guideline For Management Of Nausea And Vomiting Of Pregnancy And Hyperemesis Gravidarum (2019). It may be helpful to print these guidelines out and take it with you to your doctor’s appointments.
Ondansetron 4-8mg taken orally two to three times daily
H2 antagonist eg. Ranitidine 150-300mg orally twice daily
Routine administration of IV fluids 1-3 x per week (your GP or OB should arrange for this to be done via the maternity ward or outpatient clinic to avoid the emergency department)
In the event that the above regime does not provide enough relief from symptoms the following can be discussed with your care provider or a specialist:
Steroid treatment
Extended hospital admission
Nutritional support therapies
Managing the condition
How in-depth the plan needs to be will partly depend on how severe your condition was last time. For example, if you did not require admission to hospital last time then you are unlikely to need to make a plan for regular fluids this time. However, if you were admitted repeatedly for IV fluids throughout your previous pregnancy or were unable to take some medications then your care plan needs to take those things into account.
Things to think about and discuss/plan with your GP/consultant include:
At what point you should start initial treatment and at what level of sickness you would consider a need to increase treatment i.e. vomiting more than 5 times a day? Weight loss of 5% or more of pre-pregnancy weight? Not managing to drink 500ml or more of fluid per day? Other criteria? It may help to ask yourself what level of sickness would render you unable to live your life as ‘normally’ as you would if you weren’t pregnant
What criteria will you be admitted to hospital for? If there is a choice of hospitals in your area do you have a preferred one, is there a particular consultant you would like to be under?
If you need to be admitted what will the procedure be for that? i.e. avoiding having to go via ED as that can prove distressing. Can your GP/OB arrange for you to go straight to a ward?
Is there the option for IV fluids as a day patient? Is the option of home IV available in your area?
Is the doctor happy for you to monitor fluid intake/output at home and then to discuss treatment on the phone so as to avoid difficult trips to the surgery which can exacerbate symptoms and distress? Are home visits available and if deemed necessary what is the best arrangement for the surgery to make this possible
Which other adults do you give permission to discuss your condition with the doctor? This could be your partner, a parent, trusted friend or colleague?
Do you need a referral for mental health support? Many women suffer anxiety and depression during NVP and HG due to the intense and debilitating nature of the condition. It is worth considering if you might benefit from support for this. If you suffered Post Traumatic Stress Disorder or postnatal depression after your last pregnancy then it’s definitely worth discussing.
Tracking your symptoms
The PUQE-24 score is an easy way to keep track of your symptoms to see whether you are improving or deteriorating and whether treatments are working effectively. We have included the PUQE-24 questions at the end of this document - they are used to track symptoms over a 24 hour period so should be taken each day if possible. If you feel your symptoms have stabilised there is no reason to take the test - it should really only be used when you feel yourself getting worse or if you believe your current treatment regime is not working.
It can also be helpful to keep a simple diary each day - you can record your symptoms, log medication, count the number of times you vomit or dry heave and how much water you’ve been able to drink. A record like this can be helpful for doctors, especially if you end up in the emergency department, and shows them exactly what’s been going on without you having to explain it.
Hopefully, this plan will not be necessary and you may not experience pregnancy sickness to the same extent as last time. But it doesn’t hurt to be as prepared as possible, especially in the event that you do develop symptoms. Knowing that your plan is laid out and agreed to by all involved will limit how stressful pregnancy sickness can be.
Once you’ve finalised your care plan make sure that everyone who needs a copy has one, and be sure to have a version with you at all times in case you need to share it with a new doctor, nurse or midwife (this might be a printed version in your handbag or a digital copy on your phone.)