Pregnancy math

PUQE Score

How severe is your nausea and vomiting? Answer three questions about the last 24 hours. This is the PUQE-24 score, the scale doctors use to measure nausea and vomiting of pregnancy.[1][2]

In the last 24 hours, for how long have you felt nauseated or sick to your stomach?

In the last 24 hours, have you vomited or thrown up?

In the last 24 hours, how many times have you had retching or dry heaves without bringing anything up?

How would you rate your well-being today?

5 / 10

0, worst possible10, as well as before pregnancy

Part of the PUQE-24 form. It is not added to the score.[3]

Calculated on your device. Nothing you enter is sent or stored.

What your score means

Answer the three questions to see what your score means.

ACOG notes that nausea and vomiting of pregnancy is often played down and undertreated, that treating it early may prevent more serious problems, including hospital stays, and that mild cases may get better with changes in lifestyle and diet. How severe the symptoms feel to you is a key part of deciding whether, when and how to treat.[4]

Nausea and vomiting can also come from causes that have nothing to do with pregnancy, so a doctor or midwife should look at symptoms that do not fit the usual pattern.[4] If you cannot keep fluids down, contact your doctor or midwife.

Score and well-being

In a Motherisk study, women's well-being fell as their PUQE score rose.[3]

PUQE score at its worst	Median well-being (0 to 10)
Mild, 6 or less	7.5
Moderate, 7 to 12	5
Severe, 13 or more	1.5

The math behind it

Three questions, one number. The PUQE score adds three answers: hours of nausea, number of vomiting episodes and number of retching episodes, each scored 1 to 5.

Nausea + Vomiting + Retching = PUQE score

The Motherisk team in Toronto built the original PUQE in 2002. Its three items tracked the longer 8-item Rhodes score very closely (r = 0.904), and changes after a week matched even more closely (r = 0.95).[1] The first version asked about the last 12 hours. In 2009 the team validated a 24-hour version, because 12 hours can include sleep and miss symptoms. The 24-hour score matched hospital and emergency visits, ability to take vitamins and the woman's own rating of her well-being.[2]

Use it to track change. The score is most useful repeated over days, to see whether treatment is working. The tool keeps your answers in the link, so you can save today's result and compare.

Twenty years on, its authors report that PUQE has been built into practice guidelines around the world.[5]

Sources

Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002;186(5 Suppl):S228-31. doi:10.1067/mob.2002.123054

Used for: original PUQE, correlation with the Rhodes score.

Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can. 2009;31(9):803-7. doi:10.1016/S1701-2163(16)34298-0

Used for: 24-hour version and its validation.

Maltepe C, Koren G. Preemptive treatment of nausea and vomiting of pregnancy: results of a randomized controlled trial. Obstet Gynecol Int. 2013;2013:809787. doi:10.1155/2013/809787

Used for: PUQE-24 questions, points and score bands (Table 2); well-being by score band.

ACOG Practice Bulletin No. 189: nausea and vomiting of pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. doi:10.1097/AOG.0000000000002456

Used for: undertreatment, early treatment, role of the woman's own rating, other causes.

Koren G, Cohen R. Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE). J Obstet Gynaecol. 2021;41(3):335-9. doi:10.1080/01443615.2020.1787968

Used for: use of PUQE in guidelines.