Receiving, Intravenous fluids for Moderate to Severe nausea and vomiting in pregnancy, at home, In the Community (IMSIC)

Delivery of intravenous fluid therapy (Hartmans Fluid 3 L/24hrs per day) at home for women presenting to hospital emergency department (ED) with NVPHG who have a PUQE-24 score of greater than or equal to seven. Women who have consented to receive intravenous fluid therapy at home will be provided with a fact/information sheet about NVPHG. Women will receive usual care in the ED going home with an intravenous cannula (IVC) in place to received further intravenous fluid therapy (IVT) in their home. IVT at home will be administered over three consecutive days by a home visiting community midwife or nurse. This three day management of NVPHG at home will follow existing local health district (LHD) ambulatory care guidelines for women with NVPHG. Women will be asked to complete a Nausea and vomiting of pregnancy quality of life questionnaire (NVPQOL), the Productivity Cost Questionnaire (iPCQ) and the EQ-5D-3L survey at study entry and on completion of the three days of IVT. Participants will be asked to complete a 24hour Pregnancy unique quantifier of emesis (PUQE-24) daily over the three days of treatment then at study follow up phone call, along with a satisfaction survey. The community midwife or nurse will complete a Visual infusion Phlebitis score (VIP) score daily of the IVC site. The PUQE-24 score will assist the home visiting midwife or nurse to assess effectiveness of IVT for each women and arrange appropriate medical review. Women will receive two to three litres of IVT each day, delivered at 500 ml to one litre per hour. The three day IVT management plan can be re commenced as many times as a women requires for the duration of her NVPHG. Strategies to monitor adherence include: measurement of fluid left each day by visiting staff, interrogation of pump for running times and errors and daily assessment by visiting staff to assess if any other medications taken Qualitative interviews will be conducted with 10 to 15 participants in the intervention and analysed thematically. Clinicians and managers (6 to 10) involved in the care of women with hyperemesis gravidarum will be sought to participate in qualitative interviews that will be analysed using content analysis to assess fidelity. Every woman sequentially will be invited to partake in the qualitative interviews. We expect to require about 6-10 women to reach saturation.