AIBU to think maternity triage dismissed severe pregnancy sickness and dehydration?

[MyLoudOtter]

Hi everyone. I’m 8+4 weeks pregnant & need some perspective.
I’ve had severe sickness and extreme aversions for 4 weeks. Tonight, I saw the out of hours GP. He was thorough, scored my sickness as severe (PUQE 14), and noted clear signs of dehydration: sunken eyes, dark urine, and my pulse jumping from 78 to 125 bpm just from standing. He and his senior doctor formally agreed I needed to go to maternity triage for IV fluids.
At triage, the midwife was dismissive and rude. She didn't do a single set of obs and refused to take bloods.

She just looked at my urine and said because there was only a trace of ketones, she couldn't give me fluids. She claimed the GP "couldn't be bothered with me," gave me an anti-sickness injection, and sent me home telling me to "just drink 3L of water and eat melon."
Hours later, the injection hasn't worked. I'm still freezing, dizzy, and feeling sick. I forced down some Lucozade and chips out of desperation, but I still feel awful.

AIBU to think triage completely failed their duty of care by ignoring a GP referral and my symptoms? Or is it normal to refuse fluids based only on trace ketones, completely ignoring a racing heart and dizziness?

sorry you are feeling unwell. At 8 weeks it is very unusual to be going to maternity for this as it would normally be an and e or early pregnancy/gynae. Maternity is usually from 20 weeks pregnant. Sickness can be very common at this stage of pregnancy and if you feel very dehydrated and unwell you should go to an and e tongiht. It really should have been the GP to be honest that sorted out anti sickness medication snd and an appropriate place for IV fluids if they felt you required them.

No- not normal at all. They should have taken bloods,and examined you- also it’s well known that ketones aren’t the best indicator of dehydration. Call pregnancy sickness support and check out their resources
https://pregnancysicknesssupport.org.uk/ketones-why-they-are-not-an-indicator-of-dehydration/

I would go back and insist on treatment- IV fluids and also medication prescription, xonvea is really effective but other antisickness are also good.

I am sorry you have been dismissed and feel so awful, it’s really bad and I hope you get the treatment you need soon. Pregnancy sickness and hyperemesis is no joke and having a HCP who takes it seriously and can give you some treatment can make a massive difference.

He referred me to the maternity triage as that’s the place they do fluids at my hospital. He done it via the phone when I was in the room and they said that was fine, when I tot there it was a totally Different story. I just feel so deflated.

Please push your GP to prescribe Xonvea, it was life changing for me when I was pregnant and could barely swallow water without bringing back up

Just to correct an earlier point - maternity triage is normally from 12 weeks, not 20 - during the first trimester it would normally be A&E and EPU, which generally falls under gynaecology. Is there an EPU at your hospital?

Have you been able to keep the lucozade down? The midwife had a point about your GP in that they
don’t seem to have tried to do anything about the root cause of your sickness - did they give you any anti-emetics at all before sending you
to maternity triage? If they don’t address your nausea then a fluid IV will be a bit like mopping the floor without fixing the water leak. They absolutely should not have been dismissive though and you should contact PALs at your hospital trust to feed back on the experience.

if you manage to keep the lucozade down after an hour, try and have more fluids as much as you can - it’s important to rehydrate before the anti-emetic injection wears off. If you don’t manage it even with the injection and you still feel unwell then you should go to a&e.

When I was on the antenatal ward last year being induced at 41 weeks pregnant, there was a girl in the bed next to me who was 10 weeks along and had been admitted for dehydration and severe sickness (was not fun spending the night next to her). So can totally believe that OP was referred there correctly.

OP, I would speak to your GP again and explain what happened at triage. It doesn't sound right.

zofran was literally the only thing that helped ease the hyperemesis that was wrong what they did to you and you should report the unit that sent you away it sounds like you have hyperemesis gravidarum which is a severe pregnancy sickness and they are meant to be pro active in giving your fluid before the ketones get worse! Please get your support system to help you on this and going back to maternity unit to get your iv fluids which should be anti sickness vitamins and water through a cannuela on a maternity day ward! I am rooting for you! You got this

I don’t think she ignored you she triaged you and you didn’t meet the threshold for admission.
Youve managed Lucozade which tbh Im suprised anyone can tolerate (yuk) and chips.
Your sickness will rise at exactly this time as your HCG levels rise to suppress your period. Should ease in the next week a little amd rise again 12 weeks approaches. .
Keep drinking or sipping water or ice cubes and rest.
It’s debilitating and I feel for you. Ask your GP to prescribe a regular anti emetic my daughter did and it keepnitvmore manageable and she can work.

Not all triage units are the same. Out local one is from 18 weeks. Anything before is A&E

Yes it must be regional as anything under 20 weeks here goes to early pregnancy unit/gynae

I had hyperemesis and I had to have quite a lot of IV fluids and anti-sickness injections during my pregnancy. It was always based upon ketones in my urine. Yes, you could have dark eyes etc but it always went upon the number of ketones. They have to base it upon something as guidelines. Also, the fact that you have managed chips and lucozade is positive as there is no way I would have managed that! This is why they have to base it upon something as you do not seem to be at the threshold for needing IV fluids as of yet. I would definitely say to go to your own GP and ask for anti-sickness tablets. You will likely have to try several until you find the right one for you so it is best to go as soon as possible. Usually they have to prescribe them in a certain order. I hope the sickness eases off. As another poster has suggested, ice cubes! Little sips of water taken regularly also. Congratulations on your pregnancy

Meant to add that she shouldn't have told that the GP couldn't be bothered with you however it is common for a different line of treatment to be followed based upon their own assessment of you. It happens in every department. The GP followed procedure by referring you and you have now been properly looked at and an assessment completed. I wouldn't be complaining about this if that is something you had been considering. Hope the sickness stays away

Sick of these heartless midwives, I’ve had 3 kids and with all of my children there has always been one that made me feel like an absolute idiot !

Op could it be HG?

If your doctor did a thorough assessment, and the midwife did 1 test, I'd be inclined to go with the thorough assessment.

If you don't have an EPU, please go back to your GP. He needs to know you're still feeling that unwell, and how they responded. Not "getting them in trouble" but so that he can give you some anti emetics or advocate for you and send you somewhere else/back there with a specific person or appt time in place.

She expressed her frustration with the constant issue they faced with general practice not doing their job and 'dumping' their patients on secondary care hence taking time away from patients they do need to treat.

Ketone IS the threshold, you didn't meet it and managed to eat and drink. It's horrible to feel so sick during pregnancy but it is also very common and is mostly managed in primary care.

If she was rude to you, bring it up, but otherwise, she did nothing wrong.

You're absolutely wrong, as was the midwife. Yeh RCOG has updated their guidelines. Ketones are no longer to be used to guide clinical assessment and treatment.

OP, go back to GP. You need antiemetics. Cyclizine and Metaclopromide are usually first line medications, Xonvea a second line if those don't work for you. With things like cyclizine, you don't need to let them build up in your system - you'll know in a few hours if they're going to work for you or not.

I would second a call to the sickness in pregnancy group - they are a godsend, have clinicians answering calls. I've had HG three times, and it's not something to fuck about with. I was on Xonvea for my last, as front line medications weren't doing it, and it was a revelation.

I would also recommend getting signed off for a week or so whilst you get this sorted and stabilised.

Ketone is NOT the threshold - this has recently been dropped from RCOG and NICE guidelines.

@OCDmamai didn’t mention keytones, I said that the midwife triaged her - which she is trained to do, and the OP didn’t meet the threshold for admission.

I’m so sorry you were treated so poorly OP. Unfortunately, there are many people (some of them healthcare professionals) who just don’t understand severe pregnancy sickness/ HG. You need help and you need IV fluids and then reliable medication to keep the sickness under control.

As PPs have said, contact pregnancy sickness support. Unfortunately you have to learn to advocate for yourself in the system and fight for what you need because there is still too much ignorance and dismissal of this condition. I know it’s the last thing you have the energy for right now, but there are safe and effective medications available that can help reduce your symptoms. PSS will be able to help guide you through the system.

I agree. I had HG when I was pregnant and it’s no fun. I was hospitalised a few times. The midwife sounds super dismissive.

I’m sorry but you need to make some
NHS staff take responsibility now and understand that their actions may have adverse consequences for them too.

Always take a pen and paper and ask for their name and position. Then say ‘ so let me get this accurately. You’re saying that notwithstanding x or Y ( eg referral from GP and agreement on phone from here that I should come in for x or y) you don’t consider any tests are necessary and are referring me back to GP. Is that right? ‘ or tell them you’re recording their advice so you remember it.

No need to be antagonistic or rude but important that they are put on the spot personally as accountable for their actions and advice.

Go back if you still can’t keep fluids down. I don’t trust them after my experience

When I had HG I went to my GP, out of hours, and A&E at least three times over the course of a week. All of them turned me away, the A&E doctor literally just looked at my eyes and pinched the skin on my hand before declaring I was fine despite me telling him I’d kept nothing at all down for 3 days.

Eventually I was taken to hospital via ambulance after my Mum found me vomiting blood. I had a severe kidney injury and it was touch and go as to whether I would need dialysis. Most terrifying experience of my life.

And the midwife was wrong to say that ketones were the current assessment criteria for treatment. So her training is lacking and inadequate.

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