Comparison of Three Outpatient Regimens in the Management of Nausea and Vomiting in Pregnancy

Bsat, Fadi; Hoffman, Despina E; Seubert, David

doi:10.1038/sj.jp.7210986

Cited by 56 publications

(40 citation statements)

References 17 publications

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“…A randomized control study of 75 patients hospitalized for hyperemesis gravidarum did not demonstrate a difference in effectiveness between intravenous treatment with 25 mg promethazine or 10 mg metoclopramide every 8 h for 24 h [43]. As an initial therapeutic agent, a study of promethazine versus metoclopramide in combination with pyroxamine showed that the later treatment resulted in higher rates of reported improvement as stated by patients [44]. Promethazine has been shown to cross the placental barrier and be expressed in breast milk.…”

Section: Promethazinementioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

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Section: Promethazinementioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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“…These findings do not lend any support to pyridoxine effectiveness in HG when used in conjunction with metoclopramide. A recent study with 3 outpatient treatment arms, comparing pyridoxine-metoclopramide, prochlorperazine or promethazine for NVP, has shown pyridoxine-metoclopramide therapy to be superior, but the study design did not allow for the separate effect of pyridoxine to be assessed [16] .…”

Section: Discussionmentioning

confidence: 99%

A Placebo-Controlled Trial of Oral Pyridoxine in Hyperemesis Gravidarum

Tan¹,

Yow²,

Omar³

2008

Gynecol Obstet Invest

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Objective: To evaluate oral pyridoxine in conjunction with standard therapy in women hospitalized for hyperemesis gravidarum (HG). Methods: Patients with HG were randomized at hospitalization to 20 mg oral pyridoxine thrice daily or to placebo. Intravenous rehydration, metoclopramide and oral thiamine were also administered. Metoclopramide and thiamine were continued for 2 weeks after discharge. Rehospitalization for HG in the 2-week study period was ascertained, vomiting was recorded by diary, and nausea was evaluated with a 10-point visual analogue scale (VAS) at enrolment, after hospital discharge and on week 1 and 2 reviews. Results: Ninety-two women were included in the analysis. The rehospitalization rate was 37.5 versus 21.1% (relative risk 1.8, 95% confidence interval 0.9–3.7, p = 0.14) for pyridoxine and placebo, respectively. Daily vomiting episodes after discharge were not different (mean ± SD): 1.9 ± 2.4 versus 1.4 ± 1.1, p = 0.28 during week 1 and 1.4 ± 1.3 versus 1.4 ± 1.6, p = 0.98 during week 2. Repeated-measures analysis of variance showed no difference in the nausea visual analogue scale (p = 0.59). Conclusion: The use of oral pyridoxine in conjunction with metoclopramide during the inpatient stay and during the 2 weeks after hospital discharge for hyperemesis gravidarum did not improve the rehospitalization rate, the vomiting frequency or the nausea score. Larger studies need to be done.

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“…However, there is no clear data as to the most appropriate drug if these are ineffective. In a study of 174 singleton pregnancies with nausea and vomiting, combined therapy with pyridoxine and metoclopramide was found to be superior to monotherapy with either promethazine or prochlormethazine [61].…”

Section: Treatmentmentioning

confidence: 98%

Pregnancy-Associated Liver Disorders

Hepburn

2008

Dig Dis Sci

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Liver disorders associated with pregnancy include hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), preeclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP), and acute fatty liver of pregnancy (AFLP). These conditions are relatively common and unique to pregnancy and are more likely to occur at certain terms of gestation specific to each condition. They can be associated with significant maternal and fetal morbidity and mortality. Although managing such patients may be very challenging, spontaneous resolution of the disease occurs shortly after termination of the pregnancy, usually without hepatic sequellae. Early diagnosis and timely treatment is a key to therapeutic success. This article explores the clinical features, pathophysiology, and management of these disorders.

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Comparison of Three Outpatient Regimens in the Management of Nausea and Vomiting in Pregnancy

Cited by 56 publications

References 17 publications

Hyperemesis Gravidarum: A Review of Recent Literature

Hyperemesis Gravidarum: A Review of Recent Literature

A Placebo-Controlled Trial of Oral Pyridoxine in Hyperemesis Gravidarum

Pregnancy-Associated Liver Disorders

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