Measuring outpatient outcomes of emesis and nausea management in pregnant women.
OBJECTIVE
Nausea and vomiting during pregnancy (NVP) can create a significant clinical, psychological, and economic burden for patients, health care providers, and payers. The purpose of this analysis is to describe the clinical and economic outcomes of patients diagnosed with NVP utilizing an outpatient program of nursing support and pharmacologic treatment with subcutaneous metoclopramide (SMT).


METHODS
Women with singleton gestations who were experiencing NVP and whose physicians prescribed an outpatient program with SMT between January 2000 and February 2002 were identified from a database.


METHODS
Descriptive and statistical methods were used to analyze and report incidence of treatment failure, hospitalization/emergency room (ER) visits, degree of ketonuria, and Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score at program start/stop.


RESULTS
For a treatment duration of 26.9 +/- 20.8 days, 428 women were enrolled for outpatient SMT at 10.9 +/- 3.2 weeks' gestation. Improvement in NVP symptoms was achieved in 382 women with SMT (89.3 percent), while 46 (10.7 percent) required alteration of antiemetic therapy to subcutaneous ondansetron. The PUQE score at the start of SMT was 7.8 +/- 2.9, decreasing to 3.9 +/- 1.7 by therapy completion (P < .001). At treatment initiation, a PUQE score greater than or equal to 7 was reported by 63.1 percent of women versus 9.1 percent at the program's end (P < .001). Patients with ketonuria that was more than or equal to 1+ decreased from 36.2 percent to 1.4 percent (P < .001). The portion of patients with hospital/ER visits decreased from 65.4 percent to 3.3 percent during treatment (P < .001). Oral dietary improvement was noted in 78.7 percent of patients during treatment.


CONCLUSIONS
Outpatient management was effective in controlling NVP and was associated with a reduced need for hospital or emergency room treatment.
Lombardi
David G
DG
University of Kentucky, Department of Obstetrics and Gynecology, Lexington, KY, USA.
Istwan
Niki B
NB
Rhea
Debbie J
DJ
O'Brien
John M
JM
Barton
John R
JR
D000328:Adult; D000553:Ambulatory Care; D000932:Antiemetics / Q000627:therapeutic use*; D003363:Cost Control; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D048968:Morning Sickness / Q000188:drug therapy* / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D014481:United States
D000932:Antiemetics; C075796:metoclopramide sulfide; D008787:Metoclopramide