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PUQE-24 Score (Pregnancy-Unique Quantification of Emesis)

The modified PUQE-24 rates nausea and vomiting of pregnancy from 3 to 15 using hours of nausea, vomiting episodes and retching episodes over the last 24 hours. A score of ≤6 is mild, 7–11 moderate and ≥12 severe nausea and vomiting of pregnancy.

  • In the last 24 h, how long have you felt nauseated or sick to your stomach?: Not at all (1); 1 hour or less (2); 2–3 hours (3); 4–6 hours (4); More than 6 hours (5)
  • In the last 24 h, how many times have you vomited or thrown up?: Did not throw up (1); 1–2 times (2); 3–4 times (3); 5–6 times (4); 7 or more times (5)
  • In the last 24 h, how many times have you had retching or dry heaves without bringing anything up?: No time (1); 1–2 times (2); 3–4 times (3); 5–6 times (4); 7 or more times (5)
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Interpretation

ResultMeaning
≤ 6Mild NVP
7–11Moderate NVP
≥ 12Severe NVP

Formula

Sum of 3 items each scored 1–5 over the last 24 h. Nausea: none 1, ≤1 h 2, 2–3 h 3, 4–6 h 4, >6 h 5. Vomiting: none 1, 1–2× 2, 3–4× 3, 5–6× 4, ≥7× 5. Retching/dry heaves: none 1, 1–2× 2, 3–4× 3, 5–6× 4, ≥7× 5. Range 3–15.

Clinical pearls

  • The original 2002 PUQE covered the previous 12 hours; the PUQE-24 (2009) uses 24 hours, which better captures symptoms that overlap sleep. Cut-offs are the same.
  • Hyperemesis gravidarum is a clinical diagnosis (persistent vomiting with weight loss, dehydration or ketosis); a high PUQE supports but does not define it.
  • Exclude other causes (molar pregnancy, multiple gestation, thyroid, gastrointestinal, urinary infection) when symptoms are severe or start after 10 weeks.

Examples

puqe nausea more than 6 hours, vomited 5 times, retching 3 timesPUQE-24: nausea 2-3 hours, vomiting 1-2, no retchinghow severe is her morning sickness: nauseated all day, vomiting 7+ times, constant retching

FAQ

What PUQE score is severe?

A PUQE-24 of 12 or more (out of 15) indicates severe nausea and vomiting of pregnancy; 7–11 is moderate and 6 or less is mild.

What is the difference between PUQE and PUQE-24?

The original PUQE asked about the previous 12 hours; PUQE-24 asks about the previous 24 hours. The item scoring and severity cut-offs are the same.

Evidence

  1. Koren G et al. Motherisk-PUQE scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002;186(5 Suppl):S228–31.
  2. Ebrahimi N et al. Nausea and vomiting of pregnancy: using the 24-hour PUQE-24 scale. J Obstet Gynaecol Can 2009;31:803–7.

Pediatrics & Obstetrics · Reviewed 2026-10-14 · Methodology