What are the factors used to calculate the Pregnancy-Unique Quantification of Emesis (PUQE) score?

Factors of the PUQE Score

The Pregnancy-Unique Quantification of Emesis (PUQE) score consists of three specific factors: duration of nausea in hours, number of vomiting episodes, and number of retching or dry heaving episodes over a defined time period. 1

Detailed Components of the PUQE Score

The PUQE score evaluates three key symptoms on a 5-point scale (1-5 points each):

1. Duration of Nausea: How long (in hours) has the patient felt nauseated or sick to the stomach?

   • 1 point: Not at all
   • 2 points: 1 hour
   • 3 points: 2-3 hours
   • 4 points: 4-6 hours
   • 5 points: >6 hours

2. Vomiting Episodes: How many times has the patient thrown up or vomited?

   • 1 point: No vomiting
   • 2 points: 1-2 times
   • 3 points: 3-4 times
   • 4 points: 5-6 times
   • 5 points: ≥7 times

3. Retching Episodes: How many times has the patient experienced retching or dry heaves without throwing up?

   • 1 point: None
   • 2 points: 1-2 times
   • 3 points: 3-4 times
   • 4 points: 5-6 times
   • 5 points: ≥7 times

Scoring and Interpretation

The total PUQE score is calculated by summing the points from all three categories:

• Maximum possible score: 15 points
• Severity classification:
  • ≤6 points: Mild nausea and vomiting of pregnancy
  • 7-12 points: Moderate nausea and vomiting of pregnancy
  • ≥13 points: Severe nausea and vomiting of pregnancy 1

Clinical Significance

The PUQE score has been validated through multiple studies and correlates well with:

• Ability to take multivitamin supplements
• Rates of emergency room visits and hospitalizations for NVP
• Quality of life and well-being scores
• Healthcare costs associated with NVP 2

Versions of the PUQE Score

There are two main versions of the PUQE score:

1. Original PUQE: Measures symptoms over the previous 12 hours
2. PUQE-24: An extended version that measures symptoms over 24 hours, which may better capture the full range of symptoms, especially for women who experience symptoms primarily during sleeping hours 3

The PUQE score is recommended by the American College of Gastroenterology as a tool to guide appropriate treatment decisions for nausea and vomiting during pregnancy and to prevent progression to hyperemesis gravidarum 4.