The modern aspects of the optimal therapeutic strategy of hyperemesis gravidarum

Obstetrician-gynecologist, The anesthesiologist and specialist on medical emergency conditions, Family doctor
The modern aspects of the optimal therapeutic strategy of hyperemesis gravidarum

Although nausea and vomiting in early pregnancy is very common, affecting approximately 80% of pregnancies, hyperemesis gravidarum (HG) is a severe form that complicates up to 2.2% of pregnancies. HG is one of the most common indications for hospitalization during pregnancy. In addition to the consequences of undernutrition for the mother and fetus, the severity of HG symptoms causes a serious psychosocial burden, leading to depression, anxiety and even the development of perinatal pathology. The aim of this meta-analysis was to examine all randomized controlled trials of interventions specifically for HG and evaluate them based on both subjective and objective measures of efficacy, maternal and fetal/neonatal safety, and economic costs.

A systematic data search was conducted using the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and publications in professional publications of Ukraine for 2013–2023. The search was conducted using the terms: pregnancy, nausea and vomiting of pregnant women, hyperemesis, antiemetic therapy during pregnancy, infusion therapy and the safety profile of medications prescribed during pregnancy in various combinations.

The primary outcome was the effectiveness of therapeutic strategies in reducing or stopping nausea/vomiting; breakdown by safety profile of antiemetic drugs; optimization of infusion therapy; additional clinical strategies that help improve the quality of care for pregnant women; adverse effects and side effects of drugs used to treat LBW for the mother/fetus/neonate.

The results presented in our meta-analysis can be used in the creation of a national clinical guideline, protocol, consensus or clinical recommendations regarding the clinical management of hyperemesis gravidarum.

Key words: pregnancy, early toxicosis, hyperemesis gravidarum, fetus, PUQE-24, dehydration, ketonuria, antiemetic therapy, infusion therapy, xylitol, perinatal pathology, gastroesophageal reflux, acid-suppressive therapy, parenteral therapy.

Information about the authors

  • Volodymyr Medved, MD, PhD, DSc, professor, corresponding member of the NAMS of Ukraine, head of Department Internal pathology of pregnant women, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine, ORCID: 0000-0002-4283-1211.
  • Dmytro Konkov, MD, PhD, DSc, professor, department of Obstetrics and Gynecology N. 1,Vinnytsya National Pirogov Memorial Medical University, ORCID: 0000-0002-9375-7509.
  • Ruslan Tkachenko, MD, PhD, DSc, professor, department of Obstetrics, Gynecology and Reproductology of the Shupyk National Healthcare University of Ukraine, ORCID: 0000-0003-2714-8147.
  • Olha Muntіan, PhD, associate professor of the department of Obstetrics and Gynecology N. 2, Vinnytsya National Pirogov Memorial Medical University, ORCID: 0000-0002-4298-9895.

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16 August, 2023
Konkov D.H. Muntian O.A.

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