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.
mild symptoms: ginger, B6, antihistamines, reglan
moderate symptoms: B6+doxylamine, reglan/compazine
severe symptoms: steroids? few reports
-many studies, mostly RCTs
-looks at main interventions
-some concrete recommendations from this
-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
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.