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PUQE-24 Pregnancy Nausea Test (3 questions, last 24 hours)

Take the validated 3-question PUQE-24 pregnancy nausea test in 60 seconds. Koren 2002, ACOG/RCOG endorsed. Free, no signup, results stay in your browser.

Last updated: Sources verified:

What you are about to take

The PUQE-24 measures how severe pregnancy nausea and vomiting have been over the last 24 hours. Three questions cover hours of nausea, vomiting episodes, and retching episodes. About 60 seconds. No signup. Gideon Koren and colleagues developed the PUQE in 2002 and validated the 24-hour version in 2009; the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) both endorse it as the standard severity screener for nausea and vomiting of pregnancy. Your answers stay in your browser — we never see them. Start the test below ↓

  • Validated by Koren 2002 (Am J Obstet Gynecol) and Ebrahimi/Koren 2009
  • Endorsed in ACOG Practice Bulletin 189 (2018) and RCOG Green-top 69 (2016)
  • 60 seconds, 3 questions, last 24 hours
  • Private — answers never leave your device

How the PUQE-24 is calculated

You answer three questions about the last 24 hours: how many hours of nausea, how many vomiting episodes, and how many retching episodes. Each item scores 1–5. The three are summed for a total of 3–15.

Total scorePUQE-24 bandSeverityWhat the band typically means
3–6MildTypical morning sicknessUsually self-managed; ginger + B6 + small meals
7–12ModerateFunctioning impairedACOG 2018 recommends antiemetic prescription; clinical contact this week
13–15Severe / possible HGHyperemesis screen positiveObstetric review this week; IV fluids often needed

The band matters more than the raw total. A score of 7 and a score of 12 are in the same management band; both warrant a clinical conversation about antiemetic treatment rather than wait-and-see. A change of one band between two PUQE-24 administrations is a real signal — whether things are improving with treatment or escalating without it.

When this test is useful — and when it isn’t

Useful for:

  • Quantifying severity to bring to a midwife or obstetric appointment (“I scored 11 on the PUQE-24, can we talk about antiemetics?”)
  • Tracking response to treatment day by day (a one-band drop on antiemetics is a good sign)
  • Distinguishing typical morning sickness (mild) from likely hyperemesis (severe) before the first obstetric visit

Not useful for:

  • Diagnosing hyperemesis gravidarum — a clinician confirms HG with weight loss, ketonuria, and dehydration, not score alone
  • Capturing nausea in conditions other than pregnancy
  • Predicting how the rest of your pregnancy will go — PUQE-24 is a 24-hour snapshot, not a prognostic tool

Morning sickness, hyperemesis gravidarum, and PUQE-24 — what each measures

A common confusion: people use “morning sickness” and “hyperemesis” as if they were a severity continuum with no clear boundary. They are related but clinically distinct.

Nausea and vomiting of pregnancy (NVP) is the umbrella term — symptoms affect roughly 70–80% of pregnancies and resolve in most by 16–20 weeks. Hyperemesis gravidarum (HG) is the severe form (~0.3–3% of pregnancies) defined by persistent vomiting, ≥ 5% pre-pregnancy weight loss, ketonuria, and dehydration. PUQE-24 is the screening number that flags which group you are likely in — mild NVP (3–6), moderate NVP (7–12), or screening-positive for HG (13–15). A clinician confirms HG with the clinical criteria; the score is the conversation-starter.

Hyperemesis red flags — same-day care

Call your midwife, obstetrician, or maternity assessment unit today if any of these apply:

  • Unable to keep any fluids down for 24+ hours
  • Weight loss above 5% of your pre-pregnancy weight
  • Urinating much less than usual, or urine very dark, or no urine for 8+ hours
  • Dizziness, faintness, or fainting when standing
  • Severe abdominal pain or blood in vomit
  • Confusion, vision changes, or fruity-smelling breath (ketones)

These are the documented hyperemesis warning signs in ACOG 2018 and RCOG 2016. They warrant same-day obstetric review, not next-week scheduling.

Sources verified 2026-05-17

  • Koren G, Boskovic R, Hard M, et al. Motherisk-PUQE scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002;186(5 Suppl):S228–S231. (PMID 16147725)
  • Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: using the PUQE-24 scale. J Obstet Gynaecol Can 2009;31(9):803–807.
  • American College of Obstetricians and Gynecologists. Practice Bulletin 189: Nausea and Vomiting of Pregnancy. Obstet Gynecol 2018;131:e15–e30 (reaffirmed).
  • Royal College of Obstetricians and Gynaecologists. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum. Green-top Guideline No. 69, 2016.
  • Mayo Clinic. Morning sickness — symptoms and causes. Patient guidance, last reviewed 2024.
  • Fejzo MS, Rocha N, Cimino I, et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature 2024;625:760–767.

Privacy

The PUQE-24 calculation runs entirely in your browser. Your individual answers and the calculated band never leave your device. We send one anonymous event to a privacy-respecting analytics service: your locale code and the PUQE-24 band string (for example band_moderate). No raw answers, no per-item data, no identifier of any kind.

Frequently asked questions

What does a PUQE-24 score of 13 mean?
A PUQE-24 score of 13 is in the severe band (13–15), the threshold Koren 2008 used to flag possible hyperemesis gravidarum. ACOG Practice Bulletin 189 (2018) and RCOG Green-top 69 (2016) treat this score as an indication for an obstetric review this week — typically with IV fluids and antiemetic prescription. It is not an emergency by itself, but it does mean your symptoms are no longer in the typical morning-sickness range.
At what PUQE score is morning sickness considered severe?
Severe begins at PUQE-24 ≥ 13, per the Koren 2008 validation. Bands are: mild 3–6, moderate 7–12, severe 13–15. The severe band is the operational threshold for screening hyperemesis gravidarum; ACOG and RCOG both treat it as a reason to be seen by an obstetric clinician promptly, even without other red flags.
When should I call my obstetrician about pregnancy nausea?
Call your midwife or obstetrician this week if your PUQE-24 is 7+ (moderate band) — ACOG 2018 recommends antiemetic treatment at this level rather than waiting it out. Call the same day if you cannot keep any fluids down for 24+ hours, have lost over 5% of your pre-pregnancy weight, your urine is very dark or absent for 8+ hours, you feel dizzy or faint standing up, or there is blood in vomit. These are the documented hyperemesis red flags.
What is hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is the severe form of pregnancy nausea and vomiting, affecting roughly 0.3–3% of pregnancies (ACOG 2018). It is clinically defined by persistent vomiting, ≥5% pre-pregnancy weight loss, ketonuria, and dehydration. HG is a recognised obstetric diagnosis with effective treatments — IV fluids, antiemetics, thiamine — not just severe morning sickness pushed to an extreme.
Morning sickness vs hyperemesis gravidarum — what changes?
Typical morning sickness is uncomfortable but you stay hydrated, keep food down most of the time, and lose little or no weight. Hyperemesis crosses a clinical threshold: you cannot keep fluids down, you lose ≥ 5% of your pre-pregnancy weight, you become dehydrated, and you develop ketones in urine. The PUQE-24 severe band (13–15) is the screening cutoff RCOG 2016 uses to flag this transition.
How often should I retake the PUQE-24 test?
Once a day is reasonable if symptoms are changing. The instrument asks about the last 24 hours, so retaking it within hours gives overlapping windows. If you are in the moderate or severe band, daily tracking gives your clinician a useful trend; if you are in the mild band, retake when your symptoms shift noticeably.
First-trimester vs 9+ weeks — does the timing matter?
Yes. NVP typically peaks around 9–13 weeks and improves by 16–20 weeks (ACOG 2018). A high PUQE-24 score at 7 weeks may stabilise; the same score at 14+ weeks deserves an earlier clinical call. Symptoms that start after 9 weeks for the first time, or that worsen sharply after 12 weeks, warrant obstetric review to rule out other causes.
I retched but mostly felt fine — can the PUQE-24 score still be high?
Yes, and that is by design. Retching (dry heaves) is the third PUQE-24 item because Koren 2002 found it captures the autonomic intensity of pregnancy nausea, not just visible vomiting. A short window of intense retching with little nausea otherwise can score 6–8; this is still informative and worth tracking, even if it feels less severe to you than the number suggests.
What actually causes morning sickness?
The strongest biological explanation is the placental hormone GDF15. Fejzo 2024 (Nature) showed that maternal sensitivity to GDF15 — driven by genetic variants — predicts hyperemesis risk. hCG and estrogen also contribute. Morning sickness is not caused by anxiety, diet, or how you handle pregnancy; it is hormone-driven physiology that the nervous system finds intolerable.
What helps with morning sickness — what does the evidence say?
ACOG 2018 lists first-line non-prescription options: ginger capsules (250 mg up to 4×/day; Cochrane 2014 found modest benefit) and vitamin B6 (pyridoxine, 10–25 mg every 6–8 hours). The strongest prescription option is pyridoxine + doxylamine (Diclegis/Bonjesta — FDA category A). For severe NVP, IV fluids and ondansetron have established safety (Pasternak 2013, NEJM cohort). Avoid cannabis (Volkow 2017) and stop ginger if you bruise or bleed easily.
Should I worry if my PUQE-24 score is 3 (no symptoms at all)?
A score of 3 means none of the three items registered — no nausea hours, no vomiting, no retching. This is fully compatible with healthy pregnancy; about 20% of pregnant people have minimal or no NVP. Some studies (Koren 2014, BMC Pregnancy & Childbirth) suggest mild NVP correlates with lower miscarriage rates, but absent NVP is not in itself a worrying sign. Talk to your midwife if you have other concerns.
I am severely sick and feeling hopeless — what should I do?
Severe HG is exhausting and isolating. Rates of antenatal depression and PTSD around HG are substantially elevated (Mitchell-Jones 2017, BJOG). Mention your mood at the same obstetric visit; you can take a [PHQ-9 depression screener](/calculators/phq-9-depression-screener/) too. If you are having thoughts of self-harm, call 988 (US Suicide & Crisis Lifeline) or your local crisis line — calling does not mean hospitalisation, most calls are just talking.
Can I take the PUQE-24 test for someone else (a partner, daughter)?
You can fill it in with them, but the answers should reflect their last 24 hours, not yours. The instrument is designed for the pregnant person to self-report. If your partner is too sick to type, sit beside her, read the questions aloud, and record her answers — keep the score; share it with the obstetrician.
Does the PUQE-24 calculator stay private?
Yes. The calculation runs entirely in your browser. Your individual answers never leave your device. We log one anonymous event with the PUQE-24 band (e.g. 'band_moderate'), nothing more — no raw answers, no IP, no identifier.

Sources

  1. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system — Koren G, Boskovic R, Hard M et al. — Am J Obstet Gynecol (2002) (peer reviewed, retrieved 2026-05-17)
  2. Nausea and vomiting of pregnancy: using the 24-hour PUQE-24 scale — Ebrahimi N, Maltepe C, Bournissen FG, Koren G — J Obstet Gynaecol Can (2009) (peer reviewed, retrieved 2026-05-17)
  3. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy — American College of Obstetricians and Gynecologists (ACOG, 2018, reaffirmed) (guideline, retrieved 2026-05-17)
  4. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69) — Royal College of Obstetricians and Gynaecologists (RCOG, 2016) (guideline, retrieved 2026-05-17)
  5. Nausea and vomiting of pregnancy: diagnosis and treatment — Mayo Clinic — Pregnancy & Women's Health (medical society, retrieved 2026-05-17)
  6. GDF15 linked to maternal risk of nausea and vomiting during pregnancy — Fejzo MS, Rocha N, Cimino I et al. — Nature (2024) (peer reviewed, retrieved 2026-05-17)