Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

Year 2015, Volume: 40 Issue: 1, 113 - 118, 09.09.2015

Hasan Topçu , Can İskender Aslı Oskovi Hakan Timur Korkut Dağlar Nuri Danışman

https://doi.org/10.17826/cutf.65088

Abstract

Purpose: To evaluate the risk factors of prolonged hospitalization in patients with hyperemesis gravidarum (HEG). Material and Methods: The medical records of 114 patients who were admitted to the Zekai Tahir Burak Women's Health Education and Research Hospital with a diagnosis of HEG in the period January 2013 to June 2014 were analyzed retrospectively. Hospital stay of more than 4 days was considered as prolonged hospitalization. Ninety -three patients with HEG who needed hospitalization less than four days formed the control group and 21 patients with HEG who needed hospitalization equal to or longer than four days formed the study group. The variables regarding age, body mass index, week of pregnancy, number of parity, daily vomiting number, number of days in hospital, need of combined antiemetic use, complete blood count, biochemistry markers, hormone tests, urine analysis were evaluated to assess their relationship with the risk factors for prolonged hospitalization in patients with HEG. Results: Twenty-one of 114 patients diagnosed with HEG had a prolonged hospital stay, with a mean stay of 5.1 days. Age, body mass index, week of pregnancy, need of using combined antiemetics, complete blood count parameters, liver and kidney function tests were not associated with the duration of hospitalization. Daily vomiting, maternal serum TSH levels and blood urea nitrogen levels were 2.4 ± 1.3 vs 4.2 ± 1.9; p= 0.01, 1.19 ± 0.71 vs 0.82 ± 0.67; p= 0.04, 21.2 ± 6.4 vs 18.1 ± 5.3; p= 0.03; respectively, and these differences were found to be statistically significant among groups. The serum maternal TSH < 0.1 µIU/mL and vomiting ≥ 5 per day were found to be significant indicators for longer hospitalization (OR = 4.05, 95%CI = 1.07-15.3; P <0.05, OR=9.55, 95%CI = 1.81-50.4 P <0.05; respectively). Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs

Keywords

Hyperemesis gravidarum, risk factors, pregnancy, hospitalization

Hiperemezis Gravidarum Hastalarında Uzun Süreli Hospitalizasyonun Risk Faktörleri

Abstract

Amaç: Hiperemezis gravidarum (HG) hastalarında uzun süreli hospitalizasyonun risk faktörlerinin değerlendirilmesi. Materyal ve Metod: Zekai Tahir Burak Hastanesinde Ocak 2013 ve Haziran 2014 tarihleri arasında HG tanısıyla hospitalize edilen 114 hastanın medikal kayıtları retrospektif olarak incelendi.. Hastanede kalış süresi 4 gün veya daha fazla olması uzun süren hospitalizasyon olarak tanımlandı. HG tanısını almış ve 4 günden az hastanede yatmış 93 hasta kontrol grubunu ve hastenede kalış süresi 4 gün veya daha fazla olan 21 HG tanılı hasta da çalışma grubunu oluşturdu. Yaş, vücut kitle indeksi, gebelik haftası, parite, günlük kusma sayısı, hastanede kalınan gün sayısı, kombine Araştırma Makalesi / Research Article 113 Topçu et al. Cukurova Medical Journal antiemetik kullanma ihtiyacı, tam kan sayımı, biyokimyasal markırlar, hormonal testler ve idrar analizi sonuçlarıyla HG’lı hastaların hastanede uzun kalış süreleri arasındaki ilişki değerlendirildi. Bulgular: HG tanısı almış ve uzamış hospitlizasyonu olan 21 hastanın ortalama hastanede kalış süresi 5,1 gün idi. Yaş, vücut kitle indeksi, gebelik haftası, kombine antiemetik kullanma ihtiyacı, tam kan sayımı, karaciğer ve böbrek testleri uzun süreli hospitalizasyonla ilgili bulunmadı. Günlük kusma sayısı, maternal serum TSH seviyeleri ve kan üre değerleri sırasıyla; 2.4 ± 1.3 vs 4.2 ± 1.9; p= 0.01, 1.19 ± 0.71 vs 0.82 ± 0.67; p= 0.04, 21.2 ± 6.4 vs 18.1 ± 5.3; p= 0.03 bulundu ve aradaki farklar istatistiksel olarak anlamlıydı. Maternal serum TSH seviyesinin 0.1 µIU/mL’in altında olması ve günlük kusma sayısının günde ≥ 5 olması HG’ li hastalarda uzun süre hospitalizasyon riskini arttıran faktörler olarak bulunmuştur (OR = 4.05, 95%CI = 1.07-15.3; P <0.05, OR=9.55, 95%CI = 1.81-50.4 P <0.05; sırasıyla). Sonuç: Günlük kusma sayısı ve maternal serum TSH seviyeleri klinisyenlere uzun hospitalizasyon için riskli olan HG’ li hastaları belirlemede yardımcı olabilir ancak bu bulguların daha büyük populasyonları içeren çalışmalarla doğrulanması gerekmektedir. Yüksek riskli hastaların belirlenmesi antiemetik tedaviye erken dönemde başlanabilmesi açısından önemlidir, böylece hem HG bağlı komplikasyonlar hem de ekonomik maliyetler azalacaktır.

Keywords

Hiperemezis gravidarium, risk faktörleri, gebelik, hospitalizasyon

References

• Cedergren M, Brynhildsen J, Josefsson A, Sydsjo A, Sydsjo G. Hyperemesis gravidarum that requires hospitalization and the use of antiemetic drugs in relation to maternal body composition. American journal of obstetrics and gynecology. 2008;198:412 e1-5.
• McCarthy FP, Lutomski JE, Greene RA. Hyperemesis gravidarum: current perspectives. International journal of women's health. 2014;6:719- 25.
• Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstetrics and gynecology. 2006;107:277-84.
• Einarson TR, Piwko C, Koren G. Prevalence of nausea and vomiting of pregnancy in the USA: a meta analysis. Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharamcologie clinique. 2013;20:e163-70.
• Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, et al. Hospitalizations during pregnancy among managed care enrollees. Obstetrics and gynecology. 2002;100:94-100.
• Bacak SJ, Callaghan WM, Dietz PM, Crouse C. Pregnancy-associated hospitalizations in the United States, 1999-2000. American journal of obstetrics and gynecology. 2005;192:592-7.
• Golberg D, Szilagyi A, Graves L. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstetrics and gynecology. 2007;110:695-703.
• Goodwin TM. Hyperemesis gravidarum. Clinical obstetrics and gynecology. 1998;41:597-605.
• Piwko C, Koren G, Babashov V, Vicente C, Einarson TR. Economic burden of nausea and vomiting of pregnancy in the USA. Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharamcologie clinique. 2013;20:e149-60.
• Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. International journal of women's health. 2010;2:241- 8.
• Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Human reproduction update. 2005;11:527-39.
• McCarthy FP, Khashan AS, North RA, Moss-Morris R, Baker PN, Dekker G, et al. A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy. PloS one. 2011;6:e27678.
• Tan PC, Vani S, Lim BK, Omar SZ. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. European journal of obstetrics, gynecology, and reproductive biology. 2010;149:153-8.
• Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. Journal of women's health. 2009;18:1981-7.
• Tan PC, Jacob R, Quek KF, Omar SZ. Indicators of prolonged hospital stay in hyperemesis gravidarum. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2006;93:246-7.