HG Guidelines
Guidelines for the treatment of HG are relatively new but absolutely essential to ensure that sufferers receive consistent, evidence based care across the UK.
Why do we need treatment Guidelines for Hyperemesis Gravidarum?
Guidelines are important for both professionals and sufferers. They can empower sufferers to know what treatment they can expect, and in some cases demand, alongside providing professionals with the evidence base and information to know they are offering their patients the best possible care.
National guidelines such as those outlined below, provide a consistent framework for hospitals and primary care providers to develop their own pathways for care and ensure that patients can access the care they need.
If you would like help with updating your pathways please contact us.
New RCOG Guidelines 2024
The updated Royal College of Obstetricians and Gynaecologists (RCOG) Greentop Guidelines #69 Managing Nausea and Vomiting in pregnancy and Hyperemesis Gravidarum were published in February 2024.
Since the 2016 edition, new research has been carried out along with an internationally agreed set of criteria for diagnosing HG. The updated guidelines recommend that NHS Trusts change their pathways to discourage the suggestion of ginger to hyperemesis sufferers and encourages the use of the PUQE score rather than ketones as a diagnostic tool for HG.
In support of this, PSS urge all healthcare professionals to update their HG pathways and diagnostic criteria to reflect the 2024 guidelines.
2016 RCOG Greentop Guidelines
Until 2016, there were no RCOG guidelines for the treatment of HG which left women facing huge variations in terms of treatment, with many hospitals creating their own guidelines without an evidence base.
An additional challenge that faced these guidelines was the lack of consistent diagnositic criteria for HG leading to inconsistencies across the UK and beyond.
The 2016 RCOG Greentop Guidelines No. 69, changed the treatment of HG across the UK and became the new standard of care. Link to read the 2016 guidelines below for reference only.
NICE Guidelines 2021
Let’s talk about Ketones
In the 2024 RCOG Guidelines, Ketone analysis has been dropped from the guidelines as recent research shows that ketones are neither an accurate indicator of dehydration nor a helpful measure of severity of symptoms.
Whilst women with Hyperemesis may have ketones in their urine, this is a sign of malnutrition and the body breaking down fat NOT dehydration. You can read more about why Ketones should not be included in HG pathways here and download our Ketones Poster 2023.
The use of ketone analysis when treating HG, could be a barrier to treatment and prevent women and pregnant people from accessing timely and appropriate care.
If HG guidelines in your Trust still includes Ketone analysis, please seriously consider updating it in line with the most up to date evidence.
CAN MEDICATIONS BE COMBINED?
Yes! As anti emetic medications have different mechanisms, combining them can provide more relief from symptoms than a single anti emetic.
According to the RCOG guidelines, first and second line medications can be combined along with IV Fluids and Proton Pump inhibitors to ease nausea and vomiting and associated symptoms.
Check out the RCOG guidelines 2024 for more information about combining medications.
CAN MEDICATIONS BE USED PROPHYLACTICALLY?
Yes! In cases where women have suffered HG in previous pregnancies, prophylactic medication is recommended in the RCOG guidelines to manage the onset and severity of symptoms.
For more information about which medications can be used prophylactically, check out the RCOG Guidelines 2024
WHAT IF I AM STILL WORRIED ABOUT PRESCRIBING TO MY PATIENT?
If you’ve read the RCOG guidelines and looked at the evidence around the safety of medications and you’re still unsure, refer to an Obstetric specialist at your local hospital unless your patient has a preference. Your patient deserves to receive treatment for her condition and if you’re not able to provide that, you need to refer her to someone who can.
You can also contact us to discuss your concerns.
SHARED DECISION MAKING
As with any decision about medication, discussions with pregnant patients need to be collaborative, informed and evidence-based with a clear risk v benefit analysis. Consideration should also be made of the impact of NOT treating HG which carries its own risks to both mother and baby.
Many women call our helpline desperate for support because their healthcare professional has denied them treatment. You might not believe it, but women and birthing people are often told that “no medication for sickness can be prescribed as it will harm the baby”.
HG has a devastating effect on the woman’s physical and mental health. It is crucial to remember that HG is a severe condition in which the symptoms do not just magiclly stop. It is unlikely that rest and eating little and often will have any remedial effect.
It’s estimated between 5 – 10% of women with hyperemesis will terminate their pregnancy. According to the RCOG guidelines, all avenues and options should be offered and explored prior to offering termination.
“My GP refused to give me medication because he said ‘it was harmful to the baby’. PSS were the one’s who helped me make an informed evidence-based decision.”
Charlotte Egan | Lancashire