Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

Abstract

IntroductionNausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP.MethodsWe conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses.ResultsThere was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002).ConclusionNVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition.

Determinants of Hyperemesis Gravidarum Among Pregnant Women in Public Hospitals of Mekelle City, North Ethiopia, 2019: Unmatched Case-Control Study

“…Pregnant women with moderate and high perceived stress were found to have a statistically signi cant association with hyperemesis gravidarum as compared to women who have no low stress. This nding is consistent with a study done in south Ethiopia, Egypt, Turkey, and the USA (15,22,29,30).…”

“…Women in the rst and second trimester of pregnancy were signi cantly more likely to suffer from HG than those women who were in the third trimester of pregnancy. The nding is consistent with a study conducted in Jimma University Medical Center (southwest Ethiopia) and Bale zone (south Ethiopia) and the University of Michigan(United States) (7,15,22). However, the nding contradicts a study conducted in Turkey, which shows that gestational age had no signi cant association with HG ( 23).…”

Risk Factors of Hyperemesis Gravidarum among Pregnant Women in Bale Zone Hospitals, Southeast Ethiopia: Unmatched Case-Control Study

“…Women in the first and second trimester were significantly more likely to suffer from HG than those women who were in third trimesters. This result confirmed what was reported by Sharp et al where early gestational age increased the odds of HG [21]. This could be explained by the fact that HG may be a manifestation of a woman's subconscious attempt to reject pregnancy.…”

“…Fiaschi et al mentioned that young age, lower socioeconomic status, null parity, black ethnicity, female foetus, multiple pregnancies, and history of HG in a previous pregnancy, thyroid and parathyroid disorders, and Type 1 diabetes were risk factors for HG [20]. In a large database analysis from Wisconsin school of medicine, early gestational age was associated with increased risk of HG [21].…”

Readmissions due to hyperemesis gravidarum: a nation-wide Finnish register study

“…In Finland, HG hospitalization rate of 0.7% [12] and overall incidence of 1.3% have been reported [11]. Readmission rates from 13 to 34% have been observed [4,7,[13][14][15], and average length of hospitalization has been reported to be 2-5 days [1,7,13,16,17]. Curative treatment for HG has not been discovered, and current treatment strategies aim at relieving symptoms and alleviating complications of HG, such as dehydration and malnutrition [18][19][20].…”