Prevention of nausea and vomiting during termination of pregnancy

Postoperative nausea and vomiting (PONV) is common in women undergoing dilatation and curettage under general anesthesia for pregnancy termination, and many studies suggest treating these women prophylactically for PONV.

Reviewing the antiemetics used over the past 20 years for this indication and comparing their efficacy.

We performed MEDLINE and EMBASE searches for articles published from January 1980 through June 2009. The search terms were complications, nausea, vomiting, antiemetics, anesthetics, surgery, dilatation, curettage, pregnancy, and women.

We selected the studies of the antiemetics droperidol, metoclopramide, hydroxyzine, propofol, dexamethasone, ondansetron, and ramosetron when used for the stated indication. When assessing drug efficacy, we compared the antiemetics used at the time the article was written.

We reviewed the selected studies, presented the reported incidence rates of PONV for each drug, and presented and interpreted the P values reported for the different comparisons.

Although all antiemetics assessed decreased the incidence of PONV, the combination of dexamethasone and droperidol seems to be the most effective in preventing PONV.

All antiemetics used in the last 20 years to prevent PONV are effective (some more than others) in women undergoing dilatation and curettage for pregnancy termination. However, there is a need for benefit and risk analyses of the different treatments.