Hyperemesis In Pregnancy (HIP) Trial: Inpatient versus outpatient management of severe nausea and vomiting in pregnancy

INTERVENTION: Outpatient management: Rapid outpatient rehydration Inpatient management: Standard care Women will be recruited and randomised to either inpatient or outpatient management. Both groups will be managed according to specific treatment protocols. On a daily basis during treatment information will be gathered from all participants. This will include; PUQE score (a validated scoring system used to assess symptoms of nausea and vomiting in pregnancy), eating and drinking score, wellbeing score, weight and blood test results. Treatment will continue for as long as it is clinically indicated. Women will be followed up at 7 days following discharge and the same information recorded. The number of repeat attendances and admissions will also be recorded. CONDITION: Hyperemesis gravidarum (severe nausea and vomiting of pregnancy) ; Pregnancy and Childbirth PRIMARY OUTCOME: Reduction in Pregnancy Unique Emesis Score (PUQE score) at 48 hours SECONDARY OUTCOME: 1. Number of days intravenous fluid treatment needed; 2. Number with ketonuria at 48 hours; 3. Improvement, at 2 and 7 days from start of treatment, in:; 3.1. Pregnancy‐unique quantification of emesis and nausea (PUQE) score; 3.2. Drinking and eating scores; 3.3. Wellbeing rating; 4. Weight change at 7 days; 5. Number still taking antiemetics at one week following discharge; 6. Re‐attendance episodes for hyperemesis in the seven days following discharge; 7. Costs of treatment INCLUSION CRITERIA: Pregnant women up to 20 weeks gestation with symptoms of hyperemesis gravidarum and at least 1+ ketonuria on dipstick