Hyperemesis gravidarum aggravates nausea, vomiting after caesarean delivery
Researchers conducted a retrospective cohort analysis of 76 women with hyperemesis gravidarum and 315 without, all of whom gave birth via caesarean section. The primary outcome was the incidence of postoperative nausea and vomiting (PONV), defined in the study as the admission of an anti-emetic drug within 24 hours after delivery.
More than three-quarters of the participants received intraoperative anti-emetic medications, of which 4-mg ondansetron was the most common. PONV developed in 43.4 percent and 29.6 percent of the hyperemesis gravidarum and control groups, respectively.
Logistic regression analysis was then performed. The researchers found that hyperemesis gravidarum almost doubled the risk of developing PONV (adjusted odds ratio [OR], 1.95, 95 percent confidence interval [CI], 1.13–3.36; p=0.016). This model had been adjusted for covariates, such as the use of opioids and intraoperative antiemetics.
Notably, aside from more frequent PONV, the attacks were also worse, as the researchers found that the likelihood of developing severe PONV was significantly elevated in women with hyperemesis gravidarum (adjusted OR, 1.91, 95 percent CI, 1.14–3.20; p=0.014). Other risk factors were having had multiple pregnancies and pre-existing diabetes.
“These findings have the potential to change practice, in that including hyperemesis gravidarum as part of the pre-operative assessment for CS might assist in the prediction of PONV and allow for more effective perioperative anti-emetic therapy,” the researchers said.