A comparison of the efficacy and safety of traditional Chinese medicine external treatment for the hyperemesis gravidarum: A protocol for systematic review and network meta-analysis.

BACKGROUND: The symptoms of frequent nausea and vomiting, inability to eat, and fluid imbalance caused by hyperemesis gravidarum (HG) seriously impact the quality of life of pregnant women. In some serious cases, it is even necessary to terminate the pregnancy, and threatens the life of the pregnant woman. A great many of studies have proved that HG can be effectively treated by traditional Chinese medicine (TCM) external treatment. Nevertheless, its relative effectiveness and safety haven't yet been confirmed because of the variety of TCM external treatment. Therefore, we will use the method of network meta-analysis to verify the effectiveness and safety of different types of TCM external treatment for the HG. METHODS: In this study, English and Chinese literatures that meet the requirements will be searched in EMBASE, PubMed, Cochrane Library, Web of Science, CnKI, VIP, Wanfang, and CBM. Regardless of whether blinding is used or not, all randomized controlled trials (RCTs) using TCM external treatment for the HG will be included. Then, Stata 16.0 will be used to conduct a series of pairwise meta-analysis. WinBUGS 1.4.3 and Stata 16.0 will be used to conduct Bayesian network meta-analysis to evaluate the relative results of different TCM external treatments for the HG. The quality included in the study will be evaluated through the classification of Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: This study will evaluate the effectiveness and safety of TCM external treatment for the HG according to the primary and secondary outcomes, and we rank different kinds of TCM external treatments in accordance with effectiveness. The primary outcomes are the intensity of nausea and vomiting. Secondary outcomes include quality of life, adverse outcome of pregnant women, adverse outcome of fetal, duration of hospitalization and so on. CONCLUSION: This study will provide more convincing and detailed information of TCM external treatment for the HG, and the reference value for clinical treatment. INPLASY REGISTRATION NUMBER: INPLASY 202090089.

Treatment of hyperemesis gravidarum with anthroposophic complex therapy in 3 case reports.

BACKGROUND: Hyperemesis gravidarum (HG) is generally characterized by intractable nausea and vomiting which interferes with daily life. As the cause of HG has not yet been clearly identified, conventional medicine therapies address only the symptoms. Conventional treatment is also effective for a comparatively short time and may have unfavorable side effects. Given that the condition affects more than 1% of pregnant women, there is a significant need for effective long-lasting treatments with limited side effects. CASE REPORTS: This paper is based on three case reports of pregnant women suffering from HG. They received inpatient treatment based exclusively on anthroposophic medical approaches at the Paracelsus Hospital Richterswil, Switzerland. Treatments were selected individually based on the specific patient profiles and included infusion therapy with Nux vomica, Solum uliginosum compositum and Bryophyllum pinnatum as well as art therapy (wet-on-wet painting), eurythmy therapy and rhythmical massage therapy. Anthroposophic complex therapies induced an improvement in symptoms of nausea and vomiting within one week in all three cases. CONCLUSION: Anthroposophic complex therapy is a valuable option in the treatment of HG. Well-tolerated and long-lasting, it represents a holistic and causal approach that does not only address symptoms.

[HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

Hypnosis for hyperemesis gravidarum.

Hyperemesis gravidarum--severe and persistent nausea and vomiting during pregnancy--can lead to serious negative health consequences for both mother and fetus. Appropriate evidence-based treatment for this illness is paramount. Studies describing hypnosis in the treatment of hyperemesis gravidarum (HG) were reviewed. A literature search was carried out using Cochrane, PsycINFO, PsycARTICLES, and Web of Knowledge databases. A total of 45 studies were identified by the search. Six studies fulfilled the inclusion criteria. Studies were reviewed in terms of study design, methodological quality, intervention and outcomes. Methodology between the studies differed but all reported encouraging positive outcomes. However, the quality of current evidence, based on the studies reviewed in this study, is not sufficient to establish if hypnosis is an effective treatment for HG. To be able to accurately assess the efficacy of hypnosis for HG, it is recommended that well-designed studies, e.g. randomised control trials, be carried out.

Psychiatric consultation of patients with hyperemesis gravidarum.

The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

Experience of Taiwanese women living with nausea and vomiting during pregnancy.

Two common symptoms of pregnancy are nausea and vomiting, which, for some women, cause great discomfort and profoundly impact daily life. A descriptive phenomenological method was used to understand how Taiwanese women deal with nausea and vomiting during pregnancy. A purposive sample of 10 expectant mothers participated in the study. A transcription of each informant's verbal description of her nausea and vomiting experience was made and analyzed using Colaizzi's phenomenological methodology. Four themes emerged from the interview data after inductively analyzing the narrative content concerning nausea and vomiting: 1) understanding nausea and vomiting, 2) finding coping strategies, 3) psychosocial adaptation, and 4) needing support. The results also indicated the importance of social support to pregnant women's health, including instrumental and emotional forms of support. Health professionals, however, were not mentioned in the mothers' narratives as a source of support. The issues of social support, language translation, and western and eastern perspectives on nausea and vomiting and cultural differences in perceptions of their severity are discussed.

Tactile massage and severe nausea and vomiting during pregnancy--women's experiences.

Nausea and vomiting during pregnancy is a condition with an obscure aetiology. The treatment is symptomatic but there is a lack of alternative treatments. Tactile massage is known to give relaxation and increased well-being in connection with different illnesses, but has never been studied on women with severe nausea and vomiting during pregnancy (SNVP). The aim of this study was to describe hospitalized women's experiences of SNVP and of tactile massage. A phenomenological method was used. Ten hospitalized women with SNVP were included. Each woman was given tactile massage on three separate occasions. After the final massage an open interview was used covering both the experience of severe nausea and vomiting, and of tactile massage. The findings revealed an essential meaning summarizing the experience: to obtain a relieving moment of rest and access to the whole body when nausea rules life. When nausea is experienced as controlling a woman's life, tactile massage is experienced as promoting relaxation and gives her an opportunity to regain access to her body. The findings suggest that tactile massage is a good alternative and complement to traditional treatment of SNVP.

Acupuncture versus pharmacological approach to reduce Hyperemesis gravidarum discomfort.

AIM: Several reports have suggested the use of acupuncture as a useful treatment for hyperemesis gravidarum (HG), in particular the effects on nausea intensity was underlined. The aim of this study was to compare the efficacy of acupuncture sessions plus acupressure with a metoclopramide/vitamin B12 treatment. METHODS: In this study we randomized 88 pregnant patients suffering from HG to receive either acupuncture sessions plus acupressure (acupuncture group) or metoclopramide infusion (metoclopramide group) supplemented by vitamin B12 complex. Somatic symptoms and the ability to achieve the daily routine activity (functioning) were evaluated. Acupuncture sessions were performed at the hospital twice a week for 2 weeks according to the traditional Chinese medicine criteria. Acupression was applied for 6-8 h/day. In the metoclopramide group, patients received at hospital metoclopramide infusion (20 mg/500 mL saline for 60 min) twice a week for 2 weeks. An oral supplementation with vitamin B12 complex (30 mg/day) was also prescribed. RESULTS: Both treatments reduced vomiting episodes and then nausea intensity with a consequent improvement in the rate of food intake. The effect of acupuncture seems to be progressive, increasing at the end of treatment whereas pharmacological approach has a prompt effect in responders remaining stable thereafter. Moreover, acupuncture was significantly more effective than drugs in improving functioning. CONCLUSIONS: In our study for the first time acupuncture, applied accordingly to Chinese formula, was compared to drugs demonstrating the same effect of both treatments on HG symptoms. Interestingly, functioning was significantly improved just by acupuncture. Even if the effect of acupuncture on HG discomfort remains to be confirmed, the reports on the effect of acupuncture on psychosocial variables could represent a further advantage of acupuncture application and provide an incentive to widen the base of the research.

Changing attitudes and perceptions to hyperemesis gravidarum.

A small, but significant proportion of pregnant women (1% to 2% of all pregnancies), suffer from a severe form of nausea and vomiting, which is categorised as hyperemesis gravidarum (HG). The arbitrary definition, aetiology and management of HG, which leads to conflicting attitudes and beliefs among healthcare professionals, inevitably impacts on the woman's overall experience of the condition. It causes great distress and if medical and ward staff misunderstand the condition, it can increase rather than reduce the suffering of women. A structured review was designed, both to determine the attitude and beliefs held by healthcare professionals and to advance understanding of women's experiences in relation to HG. A comprehensive search of literature was carried out. Due to the nature of the study, all the relevant identified and included articles were qualitative, therefore narrative synthesis of the tabulated results was carried out. The findings are discussed under the following themes: the experiences of the women, the various attitudes of health professionals. How the relationship between patients and health professionals is in regard to the mother's satisfaction with care and treatment. In the absence of evidence for an effective treatment, it is crucial to try and understand this complex condition, and to expand the circle of support from family to healthcare professionals involved in looking after sufferers.

The management of nausea and vomiting of pregnancy.

OBJECTIVES: To review the evidence-based management of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum. EVIDENCE: MEDLINE and Cochrane database searches were performed using the medical subject headings (MeSH) of treatment, nausea, vomiting, pregnancy, and hyperemesis gravidarum. The quality of evidence reported in these guidelines has been described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. BENEFITS: NVP has a profound effect on women's health and quality of life during pregnancy, as well as a financial impact on the health care system, and its early recognition and management are recommended. (III-B) COST: Costs, including hospitalizations, additional office visits, and time lost from work, may be reduced if NVP is treated early.

Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study.

Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS). The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.

Medical hypnosis for hyperemesis gravidarum.

Hyperemesis gravidarum in pregnancy is a serious condition that is often resistant to conservative treatments. Medical hypnosis is a well-documented alternative treatment. This article reviews the empirical studies of medical hypnosis for treating hyperemesis gravidarum, explains basic concepts, and details the treatment mechanisms. The importance of a thorough differential diagnosis and appropriate referrals is stressed. The article presents three case studies to illustrate the efficacy of this treatment approach. It is suggested that medical hypnosis should be considered as an adjunctive treatment option for those women with hyperemesis gravidarum. It is also stressed that medical hypnosis can be used to treat common morning sickness that is experienced by up to 80 percent of pregnant women. Its use could allow a more comfortable pregnancy and healthier fetal development, and could prevent cases that might otherwise proceed to full-blown hyperemesis gravidarum.

Psychiatric aspects of hyperemesis gravidarum.

Hyperemesis gravidarum is a potentially dangerous disorder of pregnancy characterized by severe and protracted vomiting. It is suggested that psychosocial factors may have a role in determining whether the pregnant woman experiences a transient spell of mild vomiting or progresses towards the much rarer but more significant pernicious vomiting. Psychotherapy, hypnotherapy and behavior therapy have been reported to contribute to the treatment of patients with hyperemesis gravidarum. A review of the etiological factors as well as of the therapeutic approaches is presented.

[Treatment of hyperemesis gravidarum by hypnosis]. / Gipnoterapiia rvoty beremennykh.

Results of hypnosuggestive treatment employed for women suffering from vomiting of pregnancy are discussed. In case of patient's consent the method works, but if any doubts of prejudices arise it fails. The main advantage of the method is a possibility to exclude or significantly reduce the damage of the fetus due to chemotherapeutic management of the condition.

Outpatient treatment of hyperemesis gravidarum with stimulus control and imagery procedures.

Hyperemesis gravidarum is a frequent illness among women in their first trimester of pregnancy. This study evaluated the use of an outpatient behavioral approach to treat hyperemesis in four women. The subjects, all health care professionals, were treated with stimulus control and imagery procedures in an A-B design, with follow-up. The results demonstrated the clinical effectiveness of outpatient behavioral treatment procedures in the management of mild/moderate hyperemesis gravidarum.