Pulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum
- 1 November 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 34 (11), 2781-2783
- https://doi.org/10.1097/01.ccm.0000242156.15757.70
Abstract
Intractable hyperemesis gravidarum remains a serious cause of morbidity among pregnant women. If not controlled, hyperemesis gravidarum can lead to severe disability, electrolyte and acid base imbalance, and even various organ system dysfunctions. From the successful use of steroids for chemotherapy-induced emesis, corticosteroids might prove useful in hyperemesis gravidarum. The purpose of this study was to compare the efficacy of pulsed hydrocortisone therapy with that of metoclopramide for the management of intractable hyperemesis gravidarum. Prospective, double-blind study. Intensive care unit of Ain Shams University Maternity Hospital. Forty patients aged 19-34 yrs having a normal appearing intrauterine pregnancy, of < or =16 wks gestation, admitted to the intensive care unit with intractable hyperemesis meeting the study criteria. Patients were randomly assigned to receive either intravenous hydrocortisone 300 mg as a daily dose or intravenous metoclopramide 10 mg 3 times daily. After 3 days the hydrocortisone was tapered completely during the course of 1 wk, whereas the metoclopramide was continued without change for 1 wk. Patients were followed up daily during the therapy course and for 2 wks following intensive care unit discharge. There was a significant reduction in vomiting episodes in the hydrocortisone group compared with the metoclopramide group (p < .0001). Within-patient analyses showed a significant reduction in mean vomiting episodes in the hydrocortisone group within the first 3 days (p < .0001). No patients from the hydrocortisone group but six of the patients receiving metoclopramide were readmitted for intractable vomiting within 1 wk from discharge. Five of them showed improvement on intravenous hydrocortisone therapy. A short course of hydrocortisone is an effective treatment for intractable hyperemesis gravidarum.Keywords
This publication has 11 references indexed in Scilit:
- Pregnancy outcome after first trimester exposure to corticosteroids: a prospective controlled studyReproductive Toxicology, 2004
- Management of hyperemesis gravidarum: the importance of weight loss as a criterion for steroid therapyQJM: An International Journal of Medicine, 2002
- Birth defects after maternal exposure to corticosteroids: Prospective cohort study and meta-analysis of epidemiological studiesTeratology, 2000
- The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: A randomized, double-blind, controlled studyAmerican Journal of Obstetrics and Gynecology, 1998
- Corticosteroids during pregnancy and oral clefts: A case-control studyTeratology, 1998
- Mineralocorticoid receptors and glucocorticoid receptorsClinical Endocrinology, 1996
- Distribution of glucocorticoid receptor immunoreactivity and mRNA in the rat brain: an immunohistochemical and in situ hybridization studyNeuroscience Research, 1996
- Dexamethasone, Granisetron, or Both for the Prevention of Nausea and Vomiting during Chemotherapy for CancerThe New England Journal of Medicine, 1995
- Postoperative Nausea and VomitingAnesthesiology, 1992
- Nausea in cancer chemotherapy is inversely related to urinary cortisol excretionBritish Journal of Cancer, 1992