When Kate Middleton was hospitalized during her last pregnancy for hyperemesis gravidarum (severe nausea and vomiting of pregnancy), it brought attention to the fact that “morning sickness” can be a serious matter. Hospitalization is a situation most pregnant women would choose to avoid, and a new study has found that day care for the problem could keep many women out of the hospital. The findings were published in the October edition of the journal Obstetrics & Gynecology by researchers at Cork University Maternity Hospital, Wilton, and the School of Economics, University College Cork, Cork, Ireland.
The study authors note that up to 80% of all pregnant women experience some form of nausea and vomiting during pregnancy. Approximately 5% of women experience hyperemesis gravidarum, which is defined as persistent and excessive vomiting starting before the end of the 22nd week of pregnancy. Approximately 50% of these women require inpatient treatment. The condition is estimated to cost a minimum of $200 million annually in in-house hospitalizations in the United States. When other factors are taken into account such as emergency department treatments, potential complications of severe vomiting, and the fact that up to 35% of women with paid employment will lose time from work through nausea and vomiting, the actual cost of this condition to the economy is significantly higher.
Historically the treatment of hyperemesis gravidarum has been performed in an inpatient setting. Day care has proven to be a beneficial and safe mode of care for patients in other clinical settings such as toxemia; therefore the researchers assessed the safety, effectiveness, and outcomes of day care treatment of the condition and compared it to inpatient treatment.
The study group comprised 98 women who were randomly assigned to initial day care management (42 women) or inpatient management (56 women). The results were calculated from the time of randomization until the hyperemesis gravidarum resolved. The women who received inpatient care experienced an average of two (range: one to four) inpatient days compared with 0 (rang: zero to two days) inpatient days for women who received day care. The women who were assigned to receive initial treatment as an inpatient had significantly more inpatient admissions (one [1–2] compared to zero [0–1] admissions for women who were assigned to day care. No significant differences were observed in day care visits. Women who were assigned to inpatient care were as satisfied with their care as those who were assigned to day care.
The authors concluded that day care treatment of hyperemesis gravidarum experienced reduced hospital inpatient stays. In addition, these women were satisfied with their care.