Oral Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2018

Development of the SOMANZ Guideline for Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (#2)

Sandra Lowe 1 , Amanda Beech 2 , Lucy Bowyer 2 , Catherine Marnoch 3 , Helen Robinson 4
  1. Royal Hospital for Women and UNSW, Randwick, NSW, Australia
  2. Royal Hospital for Women, Sydney, NSW, Australia
  3. Obstetric Medicine and Maternity Diabetes , National Women's Health, Auckland, New Zealand
  4. University of Queensland and Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane , Queensland , Australia

Nausea and vomiting in pregnancy (NVP) is a common condition affecting about 70% of women in early pregnancy with nausea alone in about one third. The incidence of hyperemesis gravidarum (HG) is much lower at 1.1% [0.8-1.3%], depending on the definition used. Numerous international guidelines have been published regarding treatment of NVP and HG, but to date there have been no comprehensive Australian/New Zealand guidelines. A writing group from the SOMANZ Council was formed to develop this document aiming to create a practical, evidence based guide to management of both NVP and HG.

The guideline will be defining NVP and HG, reviewing the differential diagnosis, outlining the epidemiology, recommended clinical assessment and appropriate investigations. Management recommendations will include who should care for these women and where treatment should take place. We will include information about the diagnosis and management of the related condition of gestational hyperthyroxinemia.

The management approach will be holistic and the guideline will make recommendations regarding non-drug treatments eg diet, acupuncture/pressure,  lifestyle and psychosocial assessment and support. The guideline will summarise the current efficacy and safety data regarding pharmacological treatment and present a hierarchical algorithm for management defining the role of antiemetics, acid suppression agents, laxatives, corticosteroids and other novel agents. These should be supplemented with appropriate use of intravenous fluids,  enteral feeding and total parenteral nutrition. This will include advice regarding preconceptual counselling for NVP and HG.

In recognition of the major impact of these conditions on women and their families, we will seek consumer input on all aspects of the guideline. We will be including a section on patient support groups and advocacy as well as developing a patient information sheet to improve patient knowledge and awareness.