Cases/Maternity and Reproductive Health

Pregnant Woman Vomiting Daily and Frightened of Taking Any Medication — Free SCA Practice Case

Pregnant woman vomiting daily and frightened of taking any medication

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Chloe Bennett

Age

28 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation.

Reason for Encounter

"I'm about nine weeks pregnant and I'm being sick every day — I feel awful. But I'm too scared to take anything in case it harms the baby. Is there anything safe I can do?"

Medical Records

●PMH: Nil significant. Gravida 1, para 0.
●Medications: Folic acid 400 micrograms OD.
●Allergies: NKDA.
●Recent contact: No recent consultations. Booked with midwife; early pregnancy progressing.

Patient Script

For the friend playing the patient role

Character Overview: You are Chloe, a 28-year-old teacher, pregnant for the first time at around nine weeks. You feel wretched with daily nausea and vomiting, but you are very anxious about taking any medication in case it harms your much-wanted baby. You are coping — just about — with fluids, but you are exhausted and worried. You want reassurance and safe advice, and you are initially reluctant about the idea of any tablets.

Opening Sentence: "Hi Doctor. I'm around nine weeks pregnant and the sickness is really getting me down — I'm being sick most mornings and feeling nauseous all day. I've read you shouldn't take anything in pregnancy, so I've just been trying to tough it out, but it's wearing me down. Is there anything safe I can do?"

History if Asked (Data Gathering Phase)

●The vomiting: "I'm vomiting two or three times a day, mostly mornings but the nausea's there most of the day. It started around six weeks and it's about the same, maybe a bit worse."
●Keeping fluids/food down: "I can keep sips of water and a bit of dry toast down most of the time, though some days are harder. I'm not managing proper meals."
●Weight/urine: "I've maybe lost a couple of pounds. I'm still passing urine, though maybe a bit less and it's darker."
●The fear of medication: "I'm terrified of taking anything — I've read horror stories about tablets in pregnancy causing harm. I'd rather suffer than risk the baby."
●What she's tried: "Ginger biscuits, small snacks, avoiding smells that set me off. It helps a little."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

●Ideas: Chloe believes that all medication in pregnancy is dangerous and that the "right" thing is to endure the sickness without treatment. "In my head, taking anything in pregnancy is a risk, full stop. I've assumed the safest thing is to just put up with it."
●Concerns: Her overriding concern is harming the baby with medication; she has not considered that severe untreated vomiting could itself be a problem. There is also a quiet worry about whether being this sick is "normal." "The only thing on my mind is not doing anything that could hurt the baby. I hadn't thought the sickness itself could be a problem — is being this sick normal?"
●Expectations: She wants safe self-help and reassurance, and is hesitant about medication. "I was hoping for safe things I can do myself. I'm nervous about tablets."

If Asked — Medical History and Medications

The patient confirms these details only when directly asked.

●Obstetric history: "First pregnancy. No previous miscarriages or problems."
●Medications: "Just my folic acid. Nothing else."
●Previous severe vomiting: "I've never had anything like this before."
●Allergies: "None."
●Multiple/molar pregnancy: "It's a single pregnancy as far as the early scan showed."

Social History and Lifestyle Impact

Chloe is a teacher. She lives with her partner.

●Work: "I'm a teacher — I've been struggling to get through the day, and I've had to leave the classroom to be sick."
●Support: "My partner's supportive. My mum's nearby."
●Lifestyle: "Non-smoker, no alcohol now I'm pregnant."
●Impact: "I'm exhausted, I dread mornings, and it's affecting my work and my mood."

If Asked — Severity and Red-Flag Screen

The patient answers these only when directly asked.

●If asked about ability to keep any fluids down over 24 hours: "I can keep small sips down most of the time, but there have been a few hours here and there when I couldn't."
●If asked about signs of dehydration (dizziness, reduced urine, dark urine): "A bit light-headed when I stand, urine's a bit darker and less than usual."
●If asked about weight loss: "A couple of pounds, I think."
●If asked about abdominal pain: "No real tummy pain, just retching."
●If asked about fever, dysuria, diarrhoea: "No fever, no burning when I wee, no diarrhoea."
●If asked about vomiting blood: "No blood."
●If asked about fetal movements: "It's too early to feel the baby move yet."
●If asked about inability to function/keep down antiemetics: "I've not tried any medication, so I don't know."

Responses to Management (The Negotiation Phase)

●If the Doctor reassures that NVP is common and does not harm the baby: "So being sick like this won't hurt the baby? That's a relief — but is it normal to be this bad?" (The tested point is reassuring appropriately while assessing severity, not dismissing it.)
●If the Doctor recommends a safe antiemetic: "But is it really safe to take something in pregnancy? I'm so scared of harming the baby." (The tested point is confidently reframing her fear — explaining that recommended antiemetics are used routinely and considered safe, and that untreated severe vomiting is itself a risk.)
●If the Doctor explains untreated vomiting can be harmful: "I hadn't thought of it that way — that not treating it could be the risky thing?"
●If the Doctor discusses when hospital assessment is needed: "When would I actually need to be seen or go in?"
●If the Doctor safety-nets: "What should I watch for that would mean I need urgent help?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Nausea and Vomiting of Pregnancy (NVP)

●NVP is very common, usually beginning in the first trimester (around 4–7 weeks), peaking around 9–11 weeks, and typically resolving by 16–20 weeks.
●It does not harm the baby and is associated with a lower miscarriage risk. Reassurance is an important part of management.

Severity Assessment and Hyperemesis Gravidarum

●Assess ability to keep fluids down, weight loss (>5% suggests hyperemesis), dehydration, ketosis, and functional impact. Validated tools (e.g. the PUQE score) can grade severity.
●Hyperemesis gravidarum is the severe end — protracted vomiting with dehydration, weight loss, and electrolyte disturbance — and may need hospital assessment and IV fluids/antiemetics.

Non-Pharmacological Measures

●Rest, small frequent bland meals, trigger avoidance, ginger, adequate hydration, and P6 acupressure are reasonable first steps for mild NVP.

Safe Antiemetics — Reframing the Fear

●First-line: antihistamines (cyclizine, promethazine) or prochlorperazine; pyridoxine–doxylamine is a licensed combination for NVP.
●Second-line: metoclopramide (short courses, given extrapyramidal side-effect risk) or ondansetron (used where benefits outweigh risks, with a shared discussion of the small association with cleft anomalies in early pregnancy).
●Recommended antiemetics are used routinely and considered appropriate in pregnancy; untreated severe vomiting and dehydration are themselves a risk, so treatment is often the safer choice.

Complications of Prolonged Vomiting

●Prolonged vomiting risks dehydration, electrolyte disturbance, ketosis, and thiamine deficiency — consider thiamine to prevent Wernicke's encephalopathy, and monitor electrolytes, particularly in hyperemesis.

When to Escalate

●Arrange same-day assessment (early pregnancy/maternity unit) for inability to keep fluids down, significant dehydration/ketosis, weight loss, or failure of oral antiemetics — for IV rehydration and antiemetics.

Safety-Netting and Follow-Up

●Safety-net for inability to keep fluids down, faintness, reduced urine output, severe abdominal pain, or haematemesis, and arrange follow-up and midwifery links.

Common Candidate Mistakes in This Case

●Colluding with the medication fear: withholding effective, safe treatment because the patient is frightened, rather than reframing the fear.
●Failing to assess severity: not distinguishing self-limiting NVP from hyperemesis, and so missing dehydration.
●Dismissing it as "just morning sickness": minimising genuine suffering and a potentially serious condition.
●Not knowing safe antiemetics: being unable to offer or reassure about appropriate options.
●Weak safety-netting/escalation: not defining when same-day assessment is needed.

Free MRCGP SCA practice case for GP registrars covering Pregnant Woman Vomiting Daily and Frightened of Taking Any Medication — Maternity and Reproductive Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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