Hyperemesis Gravidarum Top 10
- Can we find a cure? What novel or new treatments are being developed/tested/used elsewhere which could have a curative effect and to address all the symptoms of hyperemesis gravidarum rather than just the vomiting.
- How can we most effectively manage hyperemesis gravidarum? What clinical support measure is most important to people who have had hyperemesis and what did they find most beneficial? e.g. medical management, pharmaceutical review, nutrition support, rehydration, psychological support.
- What causes hyperemesis gravidarum?
- Is hyperemesis gravidarum preventable? What is the effect of preventative treatment or early intervention on the severity and duration of hyperemesis gravidarum in a subsequent pregnancy?
- What are the immediate and long-term effects of hyperemesis gravidarum (including malnutrition and dehydration, stress) on the developing foetus?
- What are the immediate and long-term effects of the various medications/treatments on the developing foetus throughout the various stages of pregnancy and in varying doses or combinations of treatments?
- What are the relative efficacies of the current medications and treatment options available? What is the optimal dose, route, timing and combination of the medications and what are the related side effects?
- What are the immediate and long term physical, mental and social consequences and complications of hyperemesis gravidarum (including malnutrition and dehydration) on the pregnant person’s body? (ie, Metabolic impact, DVT, depression, effects of dehydration)
- What clinical measurements and markers are most useful in assessing, diagnosing, managing and monitoring hyperemesis?
- What are the nutritional requirements of the 1st, 2nd and 3rd trimesters and how can people with hyperemesis gravidarum achieve these goals? i.e Oral supplements, fortifying food, dietary measures.
The following questions were also discussed and put in order of priority at the workshop:
- How can symptoms of hyperemesis gravidarum, other than vomiting, be effectively treated? For example, the nausea, excessive saliva, extreme sense of smell and fatigue.
- Why are some cases of hyperemesis gravidarum unresponsive to all antiemetics and how can we treat such cases?
- What is the risk that hyperemesis gravidarum will reoccur in a subsequent pregnancy? Does hyperemesis gravidarum get progressively worse with subsequent pregnancies and what are the risk factors for reoccurrence?
- Do clinical treatment guidelines for hyperemesis gravidarum improve management and outcomes? And if so, how can guidelines be developed and implemented nationally (where none exist) and internationally for hospital and community settings? What should be included in guidelines?
- How can people with a history of, or significant risk factors for hyperemesis gravidarum be supported to plan for a pregnancy and does such planning improve outcomes? What should a pre-pregnancy plan contain?
- How does hyperemesis gravidarum impact on a person's (and their family's) quality of life? How does quality and efficacy of treatment impact that effect?
- What is the current level of knowledge about hyperemesis gravidarum and its treatments among healthcare professionals (particularly GPs)? How can effective education for healthcare professionals be designed and delivered to improve the general knowledge and awareness of hyperemesis gravidarum among HCPs?
- What is the most effective IV rehydration regime; which solution in what quantity over what time period and how frequently? Does regular rehydration improve symptoms/outcomes/quality of life?
- What is the effect of hyperemesis gravidarum on mental health during pregnancy? What is the efficacy of psychotherapy on symptom management/pregnancy outcomes/quality of life? How can people access psycho-supportive services during pregnancy?
- What are the barriers to taking/prescribing medication for hyperemesis gravidarum? How can the risk and benefits of hyperemesis gravidarum and its treatments be better communicated to support informed decision making and consent to treatment?
- What are the barriers to accessing treatments/services and how can we reduce them to improve access?
- What healthcare services exist and how can they collaborate and be organised to better identify, treat and support people with hyperemesis gravidarum? For example, do services such as outpatient clinics or IV at home, improve outcomes and reduce the physical/mental burden of the condition?
- How can the condition be effectively managed in the community to prevent lengthy hospital admissions?
- What self-management and coping strategies and treatments do people with hyperemesis gravidarum find most helpful?
- What employment rights do people with hyperemesis gravidarum have and what financial support is available to them?
- Do specific specialist healthcare professional roles for conditions such as hyperemesis gravidarum improve outcomes? How can such roles be developed for midwives/nurses/doctors?
For full details of all of the questions identified by this PSP, please see the document below.