ABSTRACT

Aims: Nausea and vomiting in pregnancy (NVP), where there are no other underlying causes, is one of the most common symptoms in the early part of the pregnancy. It is responsible for up to 80% of pregnant population. By using PUQE score system, it is very convenient to categorize pregnant women with nausea and vomiting come to outpatient department (OPD) or general practice into those who can manage in community setting or those who need inpatient treatments. Objectives: Validation of PUQE instrument to assess NVP and hyperemesis gravidarum (HG) women in Sri Lanka.

Methods: Descriptive cross-sectional study conducted among 160 pregnant women presented to the Gynecology Unit of Teaching Hospital Anuradhapura (ATH) during three months duration. Translated self-administered PUQE questionnaire was applied to the patients with signs and symptoms with emesis in pregnancy. All study participants were undergoing clinical judgment as a confirmation test. Diagnostic test accuracy methods were used to assess criterion validity of the experimental tool. Data were analyzed by using SPSS statistical software version 25.0.

Results: Study population has a mean age of 27.96 (SD 5.31). Majority of study participants were Sinhalese and according to the parity majority were primigravida pregnancies. Majority of study participants were diagnosed as NVP Stage II (N=134:53.8%) by the PUQE scoring system. According to the clinical judgment Stage II of NVP was diagnosed among 127 (79.4%) study participants. Mean score of the PUQE scale was 9.08 (SD=2.35). Reliability assessment of the PUQE scoring system was reported as an excellent level (Cronbach alpha=0.804). Five types of management strategies were detected among study participants. Significantly high percentage of study participants were given first line antiemetics and oral rehydration solutions. Calculated sensitivity of the PUQE scoring system to diagnose Stage I of NVP was 69.56% and specificity was 96.35%. Calculated sensitivity of the PUQE scoring system to diagnose Stage II of NVP was 100% and specificity was 78.78%. All pregnant women who were clinically detected as Stage II NVP patients were detected as Stage II NVP patients by the PUQE scoring system also. None of the false positives and false negatives regarding Stage II of NVP detected by the PUQE scoring system.

Conclusion: First line antiemetics and oral rehydration solutions are usually used for treating pregnancy-related nausea and vomiting. Stage II NVP conditions were detected with a higher prevalence when NVP status was diagnosed clinically and with PUQE scoring system. Specificity of PUQE scoring system appeared higher while detecting NVP Stage I and for NVP Stage II, sensitivity of PUQE scoring system appeared high. For Stage III NVP, clinical judgments and PUQE scoring system values were completely compatible. Management strategies used for treating pregnancy-related hyperemesis status should be further studied. Conducting these studies at different study settings may help to achieve more successful results. Pregnancy unique quantification of emesis tool can be used to diagnose NVP status more descriptively. Also, this PUQE tool is a valid tool which can be effectively used for patient management. Application of PUQE scoring system should be published by planning and implementing staff awareness programs for both curative sector and public health sector.