Medline ® Abstracts for References 98-101
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Experience with oral methylprednisolone in the treatment of refractory hyperemesis gravidarum.
Safari HR, Alsulyman OM, Gherman RB, Goodwin TM
Am J Obstet Gynecol. 1998;178(5):1054.
OBJECTIVE: Our purpose was to describe the effect of oral methylprednisolone on the course of refractory hyperemesis gravidarum.
STUDY DESIGN: Patients with intractable hyperemesis gravidarum were candidates for oral methylprednisolone. Forty-eight milligrams per day was given for 3 days followed by a tapering dose over 2 weeks. If vomiting recurred after 2 weeks of therapy or during tapering, the medication was restarted or extended but not longer than 1 month total.
RESULTS: Seventeen of 18 patients (94%) were free of vomiting and were able to tolerate a regular diet within 3 days. Seven did not have further symptoms during their pregnancies. Nine vomited during or after tapering, but 7 of these responded to extension or reinstitution of therapy. Four of 6 patients on total parenteral nutrition at the start of therapy had a complete response within 3 days.
CONCLUSIONS: A short course of oral methylprednisolone appears to be a reasonable therapeutic alternative for intractable hyperemesis.
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, USA.
Successful management of hyperemesis gravidarum using steroid therapy.
Hyperemesis gravidarum causes uncontrollable vomiting, severe dehydration and muscle wasting in pregnancy and usually requires weeks or months of intravenous fluid therapy. A consecutive series of 7 women with hyperemesis gravidarum were treated with high-dose steroid therapy. Vomiting stopped within 3 h of the first dose of intravenous hydrocortisone in all patients. Maintainence oral prednisolone therapy in doses up to 45 mg/day permitted discharge from hospital within days, resumption of normal eating, reversal of muscle wasting and regain of lost weight (mean loss from prepregnant weight 10.5 +/- 4.3 kg). Prednisolone in doses of 15 mg/day or more was required for 10.6 +/- 4.7 (range 6-20) weeks. High-dose prednisolone therapy is effective in suppressing symptoms of intractable hyperemesis gravidarum and allowing normal maternal nutrition.
Department of Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Randomised, double-blind, placebo-controlled trial of corticosteroids for the treatment of hyperemesis gravidarum.
Nelson-Piercy C, Fayers P, de Swiet M
OBJECTIVE: To assess the efficacy of corticosteroids in the treatment of severe hyperemesis gravidarum refractory to conventional management.
DESIGN: Multicentre, double-blind, randomised, placebo-controlled trial.
SETTING: Inpatient gynaecology wards in eight collaborating centres.
POPULATION: Twenty-five women with severe hyperemesis of which 24 completed the one- week study period.
METHODS: Twenty-five women were randomised to receive either 40 mg prednisolone daily in two divided oral doses, or equivalent placebo tablets. If, after three days, a woman was still vomiting, medication was changed to the equivalent intravenous alternative (hydrocortisone 100 mg twice daily or normal saline injections)
MAIN OUTCOME MEASURES: Frequency of vomiting and the dependence on intravenous fluid replacement therapy after one week of treatment.
RESULTS: There was a non-significant trend towards improved nausea and vomiting and reduced dependence on intravenous fluids. However, steroid therapy led to an improved sense of wellbeing (P = 0.021), improved appetite (P = 0.039) and increased weight gain (P = 0.025) compared with placebo. There was no difference in pregnancy outcome between the treatment and placebo groups.
CONCLUSIONS: This study supports a beneficial role for steroids in severe hyperemesis, but did not validate the hypothesis that they lead to rapid and complete remission of symptoms. The study was not large enough to demonstrate a significant improvement in the primary outcome measures.
Department of Obstetric Medicine, Queen Charlotte's Hospital, London, UK.
Management of hyperemesis gravidarum: the importance of weight loss as a criterion for steroid therapy.
Moran P, Taylor R
BACKGROUND: Although the effectiveness of prednisolone therapy for severe hyperemesis gravidarum has been demonstrated, there is no consensus on how to assess severity to justify such treatment, nor any information on whether such therapy affects birth weight.
AIM: To document the effect of prednisolone therapy in women with defined severity of hyperemesis gravidarum.
DESIGN: Single centre, observational study of 30 consecutive pregnancies complicated by hyperemesis and weight loss of>5% of pre-pregnant weight between April 1995 and July 2000. Comparison of birth weight with a contemporaneous control series of women admitted with hyperemesis that was judged insufficiently severe to require steroids.
RESULTS: Treatment with prednisolone 10 mg tid rapid resolved nausea and vomiting, allowing discharge in 3 (range 1-6.5) days. Steroid therapy, which was reduced in a stepwise manner, was discontinued at a median gestation of 20 weeks. Maternal weight gain in pregnancy was restored to normal. Median birth weight in the severe, steroid-treated group was 3.33 (range 2.80-3.27) kg vs. 3.27 (range 3.04-3.53) kg in the less severe group.
CONCLUSION: Weight loss>5% served as a criterion to define a subset of women with severe hyperemesis gravidarum. In these women, steroid therapy was uniformly successful resulting in the prompt resolution of symptoms. Steroid therapy did not affect birth weight.
Department of Fetal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.