Treatment for hyperemesis gravidarum in the home: an alternative to hospitalization

Our objective was to determine whether medical therapy in the home for patients with hyperemesis gravidarum is safe, efficacious, and cost effective compared with hospitalization. In this retrospective, matched control study 50 women with hyperemesis were treated in the home and were matched for gravidity, gestational age, and weight loss from prepregnancy weight with 47 patients who were hospitalized for traditional treatment. Both groups had similar intravenous fluid and medical support until they could tolerate adequate oral intake. Women in the home had 9.7 +/- 8.0 days of intravenous therapy compared with 9.5 +/- 6.2 days in hospitalized patients (not significant). The mean percent of weight loss at initiation of therapy was similar in both groups (4.6% +/- 5.7% vs 4.5% +/- 6.1%, not significant). The mean weight change during therapy in the home group was + 1.0 +/- 4.3 pounds compared with +1.2 +/- 8.6 pounds in the hospitalized group (not significant). The only complication was infiltration of the intravenous site, the occurrence of which was similar in the two groups (40% vs 57%, not significant). At discontinuation of therapy 90% of the home patients no longer required any supportive therapy; 10% (n = 5) required hospitalization because of relapse. The cost of therapy was significantly lower for patients in the home group ($708 +/- $533 vs $2701 +/- $1717, p < 0.001). These data show that management of hyperemesis in the home is both safe and efficacious. Furthermore, successful therapy can be achieved in the home at a significantly reduced cost.