References
Outpatient models of care for pregnant women with hyperemesis gravidarum: a scoping review
Abstract
Background/Aims
Hyperemesis gravidarum can significantly impact physical and mental health and adversely affect quality of life. The aim of this review was to describe current literature regarding outpatient services for women experiencing hyperemesis gravidarum.
Methods
This scoping review searched a range of databases for studies conducted between January 2010 and October 2024.
Results
Overall, 18 papers were included. Descriptions of investigations, treatments and medications varied and were poorly reported. Outpatient care decreased inpatient admissions and length of stay without negatively impacting women's health. Women receiving outpatient care were as satisfied as those receiving inpatient care.
Conclusions
There is significant variation in outpatient models of care for hyperemesis gravidarum. Further research is needed to address the large evidence gaps in optimising models of care.
Implications for practice
Outpatient services should be considered as an alternative to inpatient care. Development of standardised, evidence-based protocols for outpatient management is required including consistent approaches to investigations, treatments and education.
Hyperemesis gravidarum is an important and under-recognised condition that can be debilitating for women. In 2021, an international Delphi survey created the Windsor definition for hyperemesis gravidarum, with the following criteria for diagnosis: pregnancy, intractable nausea and vomiting, with onset before 16 weeks' gestation, inability to eat and drink normally and significant impact on daily living (Jansen et al, 2021). Assessment tools for hyperemesis gravidarum include the pregnancy-unique quantification of emesis and nausea score to measure symptom severity. Quantification of nausea, vomiting, and retching symptoms are assessed indicating mild, moderate or severe impact (Hada et al, 2021).
While relatively rare, hyperemesis gravidarum has a reported incidence of 1.3% and is a leading cause of hospital admission for pregnant women in the first trimester of pregnancy (Nurmi et al, 2022). In addition to the physical maternal morbidity that can result in electrolyte disturbance, dehydration, malnutrition and weight loss, hyperemesis gravidarum symptoms can also cause a major psychosocial burden that may lead to depression, anxiety, suicidal ideation and pregnancy termination (Boelig et al, 2018; Nana et al, 2021). Social isolation, loss of employment, inability to perform caregiving activities and relationship strain all contribute to poor mental health outcomes for women experiencing hyperemesis gravidarum, emphasising the critical need for holistic assessment (Fletcher et al, 2015).
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