Skip navigation
Journey into the world of hyperemesis gravidarum...
25Aug 15

Have your say on the Greentop Guidelines

For the last two years my colleagues at Pregnancy Sickness Support (PSS) have been working with the Royal College of Obstetricians & Gynaecologists (RCOG) on Green Top Guidelines for the treatment of Nausea and Vomiting in Pregnancy (NVP) and Hyperemesis Gravidarum (HG). A vast amount of work has gone into these guidelines and once out they will be widely considered the gold standard of HG treatment in the UK and doctors will have to have a good reason to not follow them. So they’re really very important!

And here is your chance to get involved and influence their content. They are out for Peer Review/Public consultation at the moment, which means you can have a look at them and comment on what you think is good or bad about them and how they could be improved.

What you need to do:

Read the guidelines which are here:

Then download this pro-forma and fill it in. The download and fill in this conflicts of interest form. Don’t worry about it saying you have to be a member and all that, we’ve double checked and this is for public consultation so just put your name at the bottom and save (no need to print and sign). Then email both documents to Abid Shah ( by midnight on 31 August 2015

If you don’t use the correct pro-forma, or you don’t fill in the conflicts form, or get it in by midnight on 31 August 2015 then you will miss your chance.

Click here for all the above direct from the RCOG website.

What I feel is important to feedback:

Overall I think these guidelines are excellent very much needed here in the UK. However, I am concerned about the lack of distinction between “normal nausea and vomiting in pregnancy” (NVP) and Hyperemesis Gravidarum (HG). Particularly where evidence relating to NVP is implied to also apply to HG. So for example they mention that 90% of women will recover at 20 weeks but this is for women with NVP. Around 60% of my readers will know all too well that although they may improve around 20 weeks symptoms often go on until delivery.

And then you’ve got the bit about Ginger. I would urge my readers to speak their minds when it comes to this section. The research I did earlier this year has been accepted for publication in December and we are hoping it can therefore be incorporated into this. I’m also starting a Masters degree in Clinical Research in a couple of weeks and am planning to further bust this infuriating myth by highlighting the destruction of the patient-professional relationship when women are told to try this. It’s my feeling that the suggestion of ginger in a Greentop Guideline makes a mockery of the document.

Other points I have made in feedback are to remove the “psychological” in the aetiology section, sort out the nonsense 15% recurrence rate (it’s more like 80-86% recurrence) and I’ve complemented section 11 which I think is excellent.

If you would like to see what I’ve put on my feedback form before you fill yours in you can click here and read it.

Share with...


I 💚 this post! I'm just about to email my feedback... I'm just wondering if it's worth me saying anything about the need to pair up ondansetron with laxatives in many cases. I know you've mentioned this in your treatment ladder before so I'm thinking there must be a good reason it was left out...? It was part of a more successful drugs regime I was on by the latter stages of my pregnancy but at quite an extreme cost to my bowels... Suffice to say, without TMI, that 5 months post partum and I'm still *not quite right* due to that side effect(!) Maybe I've missed it in the draft- I was doing night feeds whilst I read some bits of the doc!!!!
Emma, 30th August 2015

Spewing Mummy replies...

Hi Emma,

For sure mention it... there is no good reason it's left out of the guideline other than an under-appreciation for the rate and severity of this side effect!

C x

Fund Hyperemesis Research

The Book

Hyperemesis Gravidarum - The Definitive Guide by Caitlin Dean

The Kids Book

Hoe to be an HG Hero by Caitlin Dean

About Me

I am mother of three beautiful children and wife to a fantastic and supportive husband. I am a nurse, a farmer and a trustee for Pregnancy Sickness Support. I love working hard and spending time with my kids.

About this blog

Information and support for pregnancy sickness and hyperemesis gravidarum. Views are my own and do not represent those of any other organisation. Information provided here should not be a substitute for medical advice. My aim is to raise awareness and encourage sufferers to know they are not alone.

Previous award nominations

MAD Blog Awards UK 2015