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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Nausea and Vomiting in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
8. Hyperemesis gravidarum: What is NOT helpful
Interventions considered not helpful for the treatment of hyperemesis:
1.Total
parenteral nutrition
has been associated with life-threatening complications.
These complications are usually secondary to central intravenous access complications. This
form of therapy may have more hazards to the patient than the underlying disorder,
and is not recommended.
Short-term
peripheral parenteral nutrition
(through a “PICC-Line”) may be
appropriate for selected cases.
2. Parenteral steroids (e.g., methylprednisolone) have not been consistently shown to be helpful in the aggregate meta-analysis data, and are no longer recommended for inpatient treatment of hyperemesis.
Most obstetricians avoid chronic
administration of corticosteroids
in pregnant women, when possible, because
prolonged use appears to increase the risk of preterm premature rupture of membranes
(PPROM). There may also be a slightly increased risk of oral clefts when the
drugs are administered before 10 weeks of gestation. Data on the efficacy of
this therapy largely derives from case reports; most randomized controlled trials
using corticosteroids for treatment of hyperemesis failed to show a significant
decrease in nausea and vomiting or number of hospital admissions.
3. There is little evidence that psychotherapy is helpful for hyperemesis, but the social situation of some patients may make short-term counseling a helpful adjunctive treatment modality.
