Summary of the Canadian consensus on management of nausea and vomiting of pregnancy

Aurel Schofield, BSc, MD, LMCC, CCFP
Executive, North American Primary Research Group, Active practice, Family Medicine Unit, Dieppe, Assistant Vice-Dean for New Brunswick/Clinical Professor, Family Medicine Program, University of Sherbrooke, Quebec, Coordinator of the Medical French Teaching Program for New Brunswick, Canada

Catherine MacKinnon, MD, FRCSC
General Obstetrician/Gynaecologist, St. Joseph's Health Centre, Assistant Professor, University of Western Ontario, London, Ontario, Canada

Nausea and vomiting of pregnancy (NVP) can have a serious impact on both the physical and the emotional aspects of women's daily lives. We recognized this major impact that NVP has on women, especially concerning the estimated loss of work time, both for women who work and those who are at home, and we have developed a learning tool for practitioners.1 To address this problem we considered optimal treatment that could reduce complications as well as save health care costs. It has been shown that women often feel neglected by their physicians, who minimize the importance of their symptoms.2 We had also previously done a needs assessment study that showed that many doctors feel ill-equipped to counsel and treat NVP. Recognizing that there was a lack of information, we thought we could create this tool to respond to current needs.

The development of the learning tool was initiated by Motherisk and developed by a multidisciplinary scientific task force that consisted of nurses, midwives, family physicians, obstetricians and gynecologists, pharmacologists and perinatologists, with a cross-country selection of individuals. Each member brought their own expertise to the table. Three meetings were held for 11/2 days each. Members prepared for the meetings by reviewing an extensive amount of literature, primarily evidence-based.

We put together a binder of material as the tool kit for an interactive medical education program, grounded on evidence-based medicine. The program is of approximately one hour's duration and can be used for small or large groups. Included are three case reports of women with different problems and varying degrees of NVP.

The specific learning objectives are to:

There are three components to the binder: the participant's workbook, the facilitator's guide, and slides, overheads and videotape. The facilitator need not be an expert on the subject of NVP. Rather, (s)he is someone who has prepared for the session by reviewing the goals and objectives of the program and understands the learning needs of the participants.

The facilitator's guide gives samples of program outlines and breakdowns of times allotted for different parts of the program. The guide also reviews the principles of active adult learning, has practical tips, and identifies the specific base knowledge which is necessary for the facilitator. Included are slide notes, giving explanations of each slide, i.e., citations and answers to frequently asked questions. The full references cited in the program can be found at the back of the binder.

The participant's workbook has paper copies of all the slides with room for note-taking, lists the citations for the references, and includes program evaluation forms.

An algorithm is used as a summary of the approach to treating NVP. It views NVP as a continuum, and that it is important to continually assess where our patients are on the continuum, from asymptomatic to severe. Emphasis is on encouraging patients to talk about NVP and on using a patient-centred approach to treatment, involving discussion of emotional aspects of the problem, self-treatment plans, and coping skills. The practitioner must validate the patient's problems, assess their severity, and determine what other information or treatment can be offered to the patient. Patient education is also a treatment, and the practitioner must help the patient understand the treatment.

The tool outlines non-pharmacologic and pharmacologic approaches, and includes therapies such as intravenous hydration, vitamin supplementation, correction of electrolyte imbalances and a complete review of other drugs that might be used for patients who have advanced from the "usual" status of NVP.

References:

  1. Koren G, von Dadelszen P, Dempster J, Einarson A, Einarson T, Ellis C, Leduc Y, MacKinnon CJ, Magee L, Pengelley H, Ross S, Schofield A, Tipping J. A Cry for Help: Nausea and Vomiting of Pregnancy. An educational program. Montreal: Duchesnay, May 1998.
  2. O'Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women's lives. Birth 1992;19:138-43.

Back to home