An interventional study of Day care and Inpatient in Hyperemesis Gravidarum, Nausea and Vomiting, sponsored by University College Cork. Completed at 1 site in Ireland. Open to female participants. Per ClinicalTrials.gov, last updated 2014-01-15.
Sponsored by University College Cork · Not applicable, Interventional, and Treatment
Upto 80% of all pregnant women experience some form of nausea and vomiting (NVP) during their pregnancy. Hyperemesis gravidarum, a more severe form of NVP affects approximately 0.3- 2.0% of pregnancies and is the commonest indication for admission to hospital in the first half of pregnancy and second only to preterm labor as a cause of hospitalization overall. According to the Hyperemesis Education and Research Foundation, conservative estimates indicate that HG can cost a minimum of $200 million annually in house hospitalizations in the United States of America. The investigators aim to conduct a randomized controlled trial to test the hypothesis that the availability of day care services for the initial treatment of NVP reduces the mean duration of stay in hospital by 1 day and results in significantly greater patient satisfaction compared with standard inpatient management.
Upto 80% of all pregnant women experience some form of nausea and vomiting during their pregnancy (NVP). The International Statistical Classification of Disease and Related Health Problems ICD-10 defines hyperemesis gravidarum (HG) as persistent and excessive vomiting starting before the end of the 22nd week of gestation, and further subdivides the condition into mild and severe, severe being associated with metabolic disturbances such as carbohydrate depletion, dehydration or electrolyte imbalance. HG is a diagnosis of exclusion, characterized by prolonged and severe nausea and vomiting, dehydration, large ketonuria and > 5% bodyweight loss.
HG affects approximately 0.3- 2.0% of pregnancies and is the commonest indication for admission to hospital in the first half of pregnancy and second only to preterm labor as a cause of hospitalisation overall. According to the Hyperemesis Education and Research Foundation, conservative estimates indicate that HG can cost a minimum of $200 million annually in house hospitalizations in the United states. Taking into account other factors such as emergency room treatments, potential complications of severe HG and the fact that up to 35% of women with paid employment will lose time from work through nausea the actual cost of NVP to the economy is significantly higher.
NVP can be extremely debilitating for the patient and if inadequately managed can cause significant morbidities including malnutrition and electrolyte imbalances, thrombosis, Wernicke's encephalopathy, depressive illness and poor pregnancy outcomes such as prematurity and small for gestational age fetuses.
Day care has proven to be beneficial and safe mode of care for patients in other clinical settings. Studies have demonstrated that day care management of patients with NVP appears acceptable and feasible but no systematic reviews or randomized controlled trials have been performed which examine the effects of introducing day care on rates of hospital admission, duration of inpatient stay and patient satisfaction.
We aim to conduct a prospective open label randomized controlled trial to test the hypothesis that the availability of day care services for the initial treatment of NVP reduces the mean duration of stay in hospital by 1 day (28.6%) and results in significantly greater patient satisfaction compared with standard inpatient management.
The null hypothesis states there is no difference in the amount of inpatient hospital days when women with NVP are treated initially in day care or by standard inpatient admission.
All pregnant women under 22 weeks gestation, who have not already been treated for NVP in their current pregnancy, presenting with the diagnosis of NVP are eligible for inclusion in the trial. The treatment group will be day care treatment of NVP. The comparison group will be the inpatient treatment of NVP.
45 studies on the registry are indexed under Hyperemesis Gravidarum; 7 are open to participants now.
This study's enrollment of 98 is above the median of 75 across 28 interventional studies indexed under Hyperemesis Gravidarum.
Browse Hyperemesis Gravidarum studies →University College Cork is the lead sponsor of 116 studies on the registry; 23 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Women (no age limits) will be admitted to the study if they have two or more of the following criteria
Exclusion Criteria:
Women will not be admitted to the study if any of the following criteria are present.
Patients randomised to day care treatment of NVP will be instructed to present to the day services unit where they will receive a pre-agreed fluid and anti emetic regimen.
Procedure: Day care
Patients randomised to inpatient management of NVP will be admitted to hospital where they will receive a pre-agreed fluid and anti emetic regimen.
Procedure: Inpatient
Patients randomised to day care treatment of NVP will be instructed to present to the day services unit where they will receive a pre-agreed fluid and anti emetic regimen.
Also known as: day unit, day services
Patients randomised to inpatient management of NVP will be admitted to hospital where they will receive a pre-agreed fluid and anti emetic regimen.
Also known as: admission
The primary outcome will be the number of inpatient nights spent in hospital secondary to NVP from initial presentation until 22 weeks gestation. An inpatient night will be defined as requiring an inpatient bed between the hours of 20.00 and 08.00.
Time frame: Following discharge
Total number of hours spent in hospital secondary to NVP from initial presentation until 22 weeks gestation.
Time frame: 22 weeks gestation
Total amount of intravenous fluids administered secondary to NVP from initial presentation until 22 weeks gestation
Time frame: 22 weeks gestation
Total amount of anti-emetics administered secondary to NVP from initial presentation until 22 weeks gestation.
Time frame: 22 weeks gestation
Total Multivitamin complexes administered secondary to NVP from initial presentation until 22 weeks gestation
Time frame: 22 weeks gestation
Patient satisfaction will be measured by the Client Satisfaction Questionnaire.
Time frame: Following first presentation
Incidence of miscarriage
Time frame: 22 weeks gestation
Infant birth weight at delivery
Time frame: Following delivery
Gestational age at delivery.
Time frame: following delivery
Total days lost at work secondary to NVP from initial presentation until 22 weeks gestation. (Asked at 16 weeks gestation)
Time frame: 16 weeks gestation
This study is completed, as verified in Jan 2014. You cannot join it, but the record below documents what was studied.
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University College Cork