Priority 7 from the Hyperemesis Gravidarum PSP

UNCERTAINTY: What are relative efficacies of the current medications and treatment options available? What are the optimal dose, route, timing and combination of the medications and what are the related side effects? (JLA PSP Priority 7)
Overall ranking	7
JLA question ID	0090/7
Explanatory note	Not available for this PSP
Evidence	Cochrane review concludes: there is little high‐quality and consistent evidence supporting any one intervention. Ref: Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. The Cochrane database of systematic reviews. 2016;5:DOI: 10.1002/14651858.CD010607.pub2. HTA SR found: there is little on the effectiveness of treatments in more severe NVP/HG. Ref: O'Donnell A, McParlin C, Robson SC, Beyer F, Moloney E, Bryant A, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Health Technol Assess. 2016;20(74):1-268
Health Research Classification System category	Reproductive health and childbirth

Extra information provided by this PSP
Original uncertainty examples	What are the options for treating it? ~ What is the best dosage of x (insert any of treatments) for most effective results for most women? What are all the options available to women who experience HG?M ~ My doctor was very dismissive. What are the recommended first, second and third line anti-emetic drugs in HG? ~ When to switch over to the first line to second line, and so on? Which is the highest dose of Cariban? ~ Best regime. Why do doctors not readily prescribe combinations of anti-emetics when patient’s symptoms appear unimproved with one anti-emetic. For example cyclizine and metoclopramide?
Submitted by	Patients x 195 ~ Healthcare professionals x 71 ~ Carers x 11 ~ Offspring x 19 ~ Organisational representatives x 5 ~ Unknown x 8

Extra information provided by this PSP

Original uncertainty examples

What are the options for treating it? ~ What is the best dosage of x (insert any of treatments) for most effective results for most women? What are all the options available to women who experience HG?M ~ My doctor was very dismissive. What are the recommended first, second and third line anti-emetic drugs in HG? ~ When to switch over to the first line to second line, and so on? Which is the highest dose of Cariban? ~ Best regime. Why do doctors not readily prescribe combinations of anti-emetics when patient’s symptoms appear unimproved with one anti-emetic. For example cyclizine and metoclopramide?

Submitted by

Patients x 195 ~ Healthcare professionals x 71 ~ Carers x 11 ~ Offspring x 19 ~ Organisational representatives x 5 ~ Unknown x 8

PSP information
PSP unique ID	0090
PSP name	Hyperemesis Gravidarum
Total number of uncertainties identified by this PSP.	65 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	9 October 2019