| A short course of methylprednisolone is more effective in preventing readmission of patients with hyperemesis gravidarum than promethazine |
Citation/s:
American Journal of Ostetrics and Gynaecology 1998 Oct 179(4) 921-4
Lead author's name and fax: HR Safari
Three-part Clinical Question: In patients with hyperemesis gravidarum
is there a higher risk of readmission if treated with steriods versus
antiemetics?
Search Terms: A Pubmed search using the term Hyperemesis gravidarum
and therapy
The Study:
Double-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Confirmed intra-uterine pregnancy of <16 weeks
gestation,with persistent vomiting, ketonuria .not responding to intrsvenous
re-hydration. Patients with molar pregnancies,medical conditions
contraindicating the use of steriods and patients in whom the aetiology of the
vomiting was unclear were excluded.
Control group (N = 20; 20 analysed): Promethazine 25mg po three times
a day for 2 weeks
Experimental group (N = 20; 20 analysed): Oral methylprednisolone 16
mg po three times a day and after 3 days , tapering the course over the next 11
days
The Evidence:
| Outcome | Time to Outcome | CER | EER | RRR | ARR | NNT |
| NO Improvement of symptoms with in 2 days of starting therapy | 2 days | 0.100 | 0.150 | -50% | -0.050 | -20 |
|---|---|---|---|---|---|---|
| 95% Confidence Intervals: | -100% to 100% | -0.254 to 0.154 | NNT = 6 to INF; NNH = 4 to INF | |||
| Readmission within 2 weeks of starting therapy | 2 weeks | 0.250 | 0 | 100% | 0.250 | 4 |
| 95% Confidence Intervals: | 0.060 to 0.440 | 2 to 17 | ||||
Comments:
This is a small randomised control study however at the time it was
published it was in fact the largest study to that date.
A follow up of the pregnancy outcome might be reqiured.
The journal search was confined to a Pubmed search and might not be
indicative of a complete search
Appraised by: Richard Foon Birmingham Women's Hospital Edgbaston.
Birmingham; Friday, January 28, 2000
Email:
Kill or Update By: Jan 2001