Pulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum.
OBJECTIVE
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.


METHODS
Prospective, double-blind study.


METHODS
Intensive care unit of Ain Shams University Maternity Hospital.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
A short course of hydrocortisone is an effective treatment for intractable hyperemesis gravidarum.
Bondok
Rasha S
RS
Department of Anaesthesiology and Intensive Care, Ain-Shams University Hospitals, Cairo, Egypt.
El Sharnouby
Noha M
NM
Eid
Hala E
HE
Abd Elmaksoud
Ahmed M
AM
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D006939:Hyperemesis Gravidarum / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008787:Metoclopramide / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D000932:Antiemetics; D008787:Metoclopramide; D006854:Hydrocortisone