Comparison of antiemetics for nausea and vomiting of pregnancy in an emergency department setting.
OBJECTIVE
To compare time from medication administration to disposition from the Emergency Department (ED) between women treated for nausea and vomiting of pregnancy with different antiemetic agents.


METHODS
We performed a retrospective cohort study of women 13 weeks gestation or less treated in our Women and Infants Hospital ED for nausea and vomiting of pregnancy between 2009 and 2011. Data was collected on patient demographics, antiemetics used, and time to disposition. We analyzed time of administration of the antiemetic used first line (ondansetron versus metoclopramide versus promethazine or prochlorperazine) to time the discharge order was placed.


RESULTS
We analyzed data from 439 women treated in the ED for nausea and vomiting of pregnancy. Forty-four percent received ondansetron alone, 47% received any other antiemetic alone, and 9% received more than one agent first line. Antiemetic agent selected did not differ by patient age, parity, current treatment for nausea and vomiting in pregnancy, orthostatics, ketonuria or disposition. We found no difference in time from medication administration to disposition between women who received ondansetron and women who received any other antiemetic (metoclopramide, prochlorperazine or promethazine). Adjusting for potential confounders, compared to patients who received any other first line therapy, patients who received ondansetron had 2.09 times the odds of having a time to disposition at or above the 75th percentile (95% CI 1.31-3.34).


CONCLUSIONS
The use of ondansetron in the ED for nausea and vomiting of pregnancy was associated with similar mean time from administration to disposition as other antiemetics.
Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Elizabeth A
EA
Mayhall
Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Robyn
R
Gray
Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
Vrishali
V
Lopes
Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI. Electronic address: kmatteson@wihri.org.
Kristen A
KA
Matteson
D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D007662:Ketosis / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008787:Metoclopramide / Q000627:therapeutic use*; D048968:Morning Sickness / Q000150:complications / Q000188:drug therapy*; D017294:Ondansetron / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011346:Prochlorperazine / Q000627:therapeutic use*; D011398:Promethazine / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000932:Antiemetics; D017294:Ondansetron; D011398:Promethazine; D008787:Metoclopramide; D011346:Prochlorperazine