Trial reportBMJ open2017
Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: a randomised control trial with patient preference arm.
Trial report in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Treatments for hyperemesis gravidarum: A systematic review.Acta obstetricia et gynecologica Scandinavica · 2024Pooled it
- Pooled it
- Effects of treatment, choice, and preference on health-related quality-of-life outcomes in patients with posttraumatic stress disorder (PTSD).Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2018Trial
- Hyperemesis gravidarum revisited: from GDF15 biology to precision multimodal therapy.Naunyn-Schmiedeberg's archives of pharmacology · 2026Review
- A scoping review of models of care and services for nausea and vomiting in pregnancy and hyperemesis gravidarum.BMC pregnancy and childbirth · 2025Article
- The impact and management of hyperemesis gravidarum: Current and future perspectives.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Review
- How are hospitals in England, Scotland and Wales caring for women with nausea and vomiting in pregnancy: a national service evaluation.BMC health services research · 2025Article
- Hyperemesis in Pregnancy: Complications and Treatment.Medical sciences (Basel, Switzerland) · 2025Review
- Diagnosis and treatment of hyperemesis gravidarum.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024Review
- Systematic evidence map of evidence addressing the top 10 priority research questions for hyperemesis gravidarum.BMJ open · 2022Article
- Article
- Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019.Obstetric medicine · 2021Article
- Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities.Frontiers in medicine · 2021Review
- Obstetric protocols in the setting of a pandemic.Seminars in perinatology · 2020Article
- ISUOG Consensus Statement on rationalization of early-pregnancy care and provision of ultrasonography in context of SARS-CoV-2.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether ambulatory (outpatient (OP)) treatment of severe nausea and vomiting of pregnancy (NVP) is as effective as inpatient (IP) care.
designNon-blinded randomised control trial (RCT) with patient preference arm.
settingTwo multicentre teaching hospitals in London.
participantsWomen less than 20 weeks' pregnant with severe NVP and associated ketonuria (>1+).
methodsWomen who agreed to the RCT were randomised via web-based application to either ambulatory or IP treatment. Women who declined randomisation underwent the treatment of their choice in the patient preference trial (PPT) arm. Treatment protocols, data collection and follow-up were the same for all participants.
main outcome measuresPrimary outcome was reduction in Pregnancy Unique Quantification of Emesis (PUQE) score 48 hours after starting treatment. Secondary outcome measures were duration of treatment, improvement in symptom scores and ketonuria at 48 hours, reattendances within 7 days of discharge and comparison of symptoms at 7 days postdischarge.
results152/174 eligible women agreed to participate with 77/152 (51%) recruited to the RCT and 75/152 (49%) to the PPT.Patients were initially compared in four groups (randomised IP, randomised OP, non-randomised IP and non-randomised OP). Comprehensive cohort analysis of participants in the randomised group (RCT) and non-randomised group (PPT) did not demonstrate any differences in patient demographics or baseline clinical characteristics. Pooled analysis of IP versus OP groups showed no difference in reduction in PUQE score at 48 hours (p=0.86). There was no difference in change in eating score (p=0.69), drinking score (p=0.77), well-being rating (p=0.64) or reduction in ketonuria (p=0.47) at 48 hours, with no difference in duration of index treatment episode (p=0.83) or reattendances within 7 days (p=0.52).
conclusionsAmbulatory management is an effective direct alternative to IP management of severe NVP. The trial also demonstrated that many women requiring treatment for severe NVP have strong preferences regarding treatment setting, which may need to be considered by care providers, especially given the psychological impact of severe NVP. TRIAL REGISTRATION NUMBER: http://www.isrctn.com/ISRCTN24659467 (March 2014).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.