Measuring Outpatient Outcomes of Emesis and Nausea Management in Pregnant Women

MANAGED CARE November 2004. ©MediMedia USA

In this study, outpatient management was effective in controlling nausea and vomiting during pregnancy and was associated with a reduced need for hospital or emergency room treatment as well as reduced costs.

David G. Lombardi, MD

University of Kentucky, Department of Obstetrics and Gynecology, Lexington, Ky.

Niki B. Istwan, RN

Matria Healthcare, Department of Clinical Research, Marietta, Ga.

Debbie J. Rhea, MPH

Matria Healthcare, Department of Clinical Research, Marietta, Ga.

John M. O'Brien, MD

Central Baptist Hospital, Division of Maternal-Fetal Medicine, Lexington, Ky.

John R. Barton, MD

Central Baptist Hospital, Division of Maternal-Fetal Medicine, Lexington, Ky.

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ABSTRACT

Purpose: 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).

Design: 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.

Methodology: 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.

Principal findings: 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.

Conclusion: Outpatient management was effective in controlling NVP and was associated with a reduced need for hospital or emergency room treatment.

Author correspondence:
Niki Istwan, RN
Matria Healthcare
1850 Parkway Place
Marietta, GA 30067

This paper has undergone peer review by appropriate members of Managed Care's Editorial Advisory Board.