Treatment for Hyperemesis

Article: Treatment for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A systematic Review. JAMA 2016

Idea: what actually works, and is safe for use in hyperemesis gravidarum?

The study: This was a database search; 67 RCTs, 11 non-randomized patients with nausea and vomiting in pregnancy and how they were treated. Outcomes were symptomatic relief.

The findings:

mild symptoms: ginger, B6, antihistamines, reglan

moderate symptoms: B6+doxylamine, reglan/compazine

–caveat: zofran>reglan/compazine

severe symptoms: steroids? few reports

Pro

-many studies, mostly RCTs

-looks at main interventions

-some concrete recommendations from this

Con

-overall low quality of evidence

-hard to compare because all the studies were so different and comparing different interventions

-many looked at “mild” symptoms, which is not really hyperemesis

Takeaway:

I don’t think this will change my practice, except it arms me with lots of options to offer at the outset. If my patient is miserable, and wants something that will work, I can do some shared decision making with them regarding zofran.

#AbdominalampGI #ObstetricsGynecology