HG Guidelines

Guidelines for the treatment of HG are relatively new but absolutely essential to ensure that sufferers receive consistent, evidence based care.

Women supporting women holding hands

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, and they can provide 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 new Royal College of Obstetricians and Gynaecologists Greentop Guidelines on Nausea and Vomiting in pregnancy and Hyperemesis Gravidarum were published in February 2024.

Since the 2016 edition new research has been carried out that suggests NHS Trusts change their pathways to discourage the  suggestion of ginger to hyperemesis sufferers and urges them to reconsider ketones as a diagnostic tool for HG. PSS therefore, urge all healthcare professionals to update their HG pathways and diagnosis 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.

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

Although there is no specific HG NICE guideline, in 2021, NICE updated their Antenatal Care Guideline to include the treatment of pregnancy sickness including HG. Many hospitals use a combination of the NICE guidelines and the RCOG guidelines when developing their own HG Pathways. It is important to remember that they cover the full spectrum of pregnancy sickness and only the recommendations for HG need to be considered.

Let’s talk about Ketones

In the 2024 RCOG Guidelines (above) Ketone analysis has been dropped from the guidelines as evidence shows that ketones are not an accurate indicator of dehydration.

Until the 2021 NICE Guidelines are updated (if hospitals and surgeries are using a combination of both) ketone analysis could be a barrier to treatment if the 2024 RCOG Guidelines are not followed.

If your pathway still includes Ketone analysis please seriously consider updating it. You can read more about why Ketones should not be included in HG pathways here and also download our Ketones Poster 2023.

Whilst women with Hyperemesis may have ketones in their urine, this is a sign of malnutrition and the body breaking down fat NOT dehydration. Until all Healthcare professionals are aware of this – women and birthing people may still be refused IV fluids. 


Yes! In many cases, medications do not work effectively enough to provide relief from the symptoms of HG on their own.

By combining first and second line medications, sufferers can experience relief from both vomiting and nausea alongside IV fluids and Proton Pump Inhibitors too.

Check out the RCOG guidelines 2024 for more information about combining medications.


Yes! In cases where women have suffered HG in previous pregnancies, prophylactic medication is recommended to manage the onset and severity of symptoms. Many first line medications can be used prophylactically.


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.


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 told often that “no medication for sickness can be prescribed as it will harm the baby”.

This has a devastating affect on the woman’s physical health and the symptoms do not just magiclly stop. With hyperemesis gravidarum it is crucial to remember that this is a severe form and it is unlikely that rest and eating little and often will have any remedial effect.

There is decades of evidence to empower healthcare professionals to describe and the RCOG Guidelines support this and now go further to say that all options have to be explored before TFMR.

Any discussion about medication needs to be informed, evidence-based and a risk/benefit analysis performed.

10% of women with hyperemesis will terminate their pregnancy. All avenues and options must be offered and explored.

“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