Low Dose Corticosteroids in Management of Hyperemesis Gravidarum at Mansoura University Hospital

Objective: to show the effect of addition of corticosteroids to standard treatment of hyperemesis gravidarum with respect to initial response of treatment, reduction of severity of vomiting , improvement of quality of life and rate of readmission to hospital .  
Design: RCT (Canadian Task Force Classification- I). 
Setting: Mansoura University Hospitals
Patients: Fifty pregnant women suffering from hyperemesis gravidarum were admitted to department of obstetrics and gynecology, Mansoura University Hospitals.
Interventions: Patients were randomized into two groups; group 1 (Corticosteroid group; n = 25) and group 2 (non-corticosteroid group; n = 25) at 1:1 ratio.
Measurements and Main Results: The primary outcome was the severity of vomiting after 48 hours after start of the treatment using Pregnancy-Unique Quantification of Emesis (PUQE) score. The secondary outcomes were quality of life after 48 hours and 1 week from starting the treatment protocol using a rating scale with a range between zero (the worst possibly imaginable) and ten (equaled as good as she felt before the start of this pregnancy) , assessment of severity of vomiting after 1 week of start of the treatment using PUQE score , rate of readmission to the hospital within 2 weeks of treatment , extent of ketonuria , and length of hospital stay. The severity of vomiting after 48 hours of start of the treatment using PUQE score decreased significantly in the corticosteroid group, being 10.64 ± 1.62 compared to 11.88 ± 1.64 in the control group. PUQE score after 1 week of start of the treatment was comparable again between the two studied groups. The quality of life (QOL) of patients after 48 hours from starting the treatment score was statistically higher among the corticosteroid group being 5.8 ± 0.8 compared to 4.6 ±1.2 in the control group p value ≤0.05 which continued after 1 week being higher among the corticosteroid group, 8.3 ±0.9 compared to 7.6 ± 0.7 in the control group. The rate of readmission to the hospital for hyperemesis gravidarum within 2 weeks of starting the study was higher among the control group being 32% versus only 4% in the group taking corticosteroids. Also, the median length of stay was higher among the control group, 7 days ranged from 4 to 28 days compared to 4 days ranged from 3 to 12 days in the corticosteroid group. 
Conclusions: Corticosteroids were highly effective in reducing the severity of vomiting in HG patients after 48 hours from the start of the treatment using PUQE score and improving their QOL score compared with the standard treatment in the control group.