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Source: Green-top guideline No. 69

Pregnancy Unique Quantification of Emesis (PUQE): It’s exquisite.

The Pregnancy Unique Qualification of Emesis (PUQE) is an objective and validated index of nausea and vomiting that clinicians use to ascertain the severity of nausea and vomiting in pregnancy.

Nausea and vomiting in pregnancy (NVP) affects up to 80% of pregnant women. Admissions due to NVP are not uncommon. Nausea and vomiting during early pregnancy without a probable cause constitute NVP. 0.3-3.6% of pregnant women experience a severe form of NVP – termed hyperemesis gravidarum.

Once diagnosed, the next task remains classifying the condition to assess which patients we treat as outpatients or inpatients – those that we should admit. The PUQE does that. Let’s explain how.

Two validated, objective measures for the severity of nausea and vomiting exist – the Rhodes Index and the Pregnancy Unique Qualification of Emesis Index. Upon validation, the Rhodes Index initially assessed nausea and vomiting in chemotherapy patients. It also ascertained the physical symptoms and the stress that resulted. Afterwards, clinicians appreciated its usefulness to assess nausea and vomiting in pregnancy. The Motherisk Program in Canada developed a shorter disease-specific questionnaire that highly correlated with the Rhodes Index – the PUQE Index.

The team at the Motherisk Program modified the PUQE and included a symptom profile over the last 24 hours, as well as, a well-being score that correlates with hydration status. A recent modification to cover more than 24 hours of symptoms and well-being has affected.
Clinicians use the PUQE Index to ascertain the severity of NVP – mild, moderate, or severe. They can also use it to track the treatment progress.

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The PUQE Index is a sum of replies to the three questions tabulated below. Clinicians classify NVP as mild if the PUQE-24 score is less or equal to 6; moderate for 7-12, and severe for 13-15. They go further to inquire how many hours a pregnant woman has slept out of 24 hours and why. They rate her well-being on a scale of 0 to 10.

In the last 24 hours, for how long have you felt nauseated or sick to your stomach?Not at all (1)1 hour or less (2)2-3 hours (3)4-6 hours (4)More than 6 hours (5)
In the last 24 hours, have you vomited or thrown up?7 or more times (5)5-6 times (4)3-4 times (3)1-2 times (2)I did not throw up (1)
In the last 24 hours, how many times have you had retching or dry heaves without bringing anything up?No time (1)1-2 times (2)3-4 times (3)5-6 times (4)7 or more times (5)

How many hours have you slept out of 24 hours? ________ Why? __________________________
On a scale of 0 to 10, how would you rate your well-being? __________________ (0 – worst possible, 10 – the best you felt before pregnancy).
Can you tell me what causes you to feel that way? _______________________________________

We should formulate a task force to design and avail the PUQE score sheet to all health care facilities across the country. It will enable clinicians to identify which pregnant women that have NVP require an admission. It will also encourage clinicians to extend the psychosocial aspect of the condition.

We extracted this information from the Green-top Guideline No.69, download.

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MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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