|
Management Of Hyperemesis Gravidarum With Acupuncture, Acupressure, And Ginger
Abraham C. Kuruvilla, MD
Molly Kresin, DO
ABSTRACT
A 26-year-old multigravida patient who presented with hyperemesis gravidarum, dehydration, proteinuria, and ketonuria was treated successfully with 2 sessions of acupuncture, multiple episodes of home acupressure, and chewing on raw ginger. This approach enabled the patient to avoid hospitalization, intravenous rehydration, and the use of antiemetic drugs.
KEY WORDS
Hyperemesis Gravidarum, Acupuncture, Acupressure, Ginger, Traditional Chinese Medicine (TCM)
INTRODUCTION
Hyperemesis gravidarum is a condition of severe nausea and vomiting associated with 1%-2% of all pregnancies and can lead to weight loss, ketonuria, proteinuria, and dehydration, often requiring hospitalization.1,2 Treatment consists of intravenous rehydration, administration of antiemetics (risking teratogenic potential), and expensive hospital management. Although the etiology is unknown, an increase in human chorionic gonadotropin, dysfunctions of thyroid, anterior pituitary, and adrenal glands, infection with Helicobacter pylori, and psychological factors have been implicated.3-5
The beneficial effects of acupressure on Pericardium 6 (PC 6) on
morning sickness have been reported.6,7 These studies excluded cases of hyperemesis gravidarum. Traditional Chinese Medicine (TCM) utilizes acupuncture and acupressure on PC 6 for the treatment of nausea and vomiting.8-10 The NIH Consensus Conference recognizes acupuncture as an effective therapy for nausea and vomiting.11
The purpose of this report is to illustrate TCM for the treatment of hyperemesis gravidarum.
CASE REPORT
A 26-year-old multigravida woman presented for evaluation of her pregnancy (at 12 weeks according to the calendar and 14 weeks by ultrasound). The patient reported increased nausea and vomiting during pregnancy with an estimated 8-lb weight loss. Increased fluid intake, small frequent meals, and vitamin B6, 25-50 mg every 8 hours, were prescribed. Follow-up 7 days later revealed further increase in nausea and vomiting with an additional 2.5-lb weight loss. The patient appeared dehydrated. Urine examination demonstrated proteinuria, ketonuria, and a specific gravity of 1.020. Hyperemesis gravidarum was diagnosed. TCM treatment was decided upon instead of hospitalization.
METHODS
Pericardium 6 points were selected for both acupuncture and acupressure. The patient gave informed consent for treatment. PC 6 was needled bilaterally and De Qi confirmed; moxabustion was done for 30 seconds on each needle. The needles were removed after 20 minutes. Acupuncture needles used were 32 gauge, 1-inch steel needles with copper heads. The patient noted a decrease in nausea at the end of the 1st treatment.
After marking PC 6 with a skin pencil bilaterally, the patient was trained to do acupressure using a ballpoint pen on the marked site. She was also advised to chew raw ginger (purchased from a grocery storeand cut into small cubes) several times daily beginning in the morning, and to return for evaluation after 4 days.
RESULTS
Four days later, the patient reported compliance with instructions. She noted a significant decrease of nausea and vomiting for the 1st 2 days; the 2nd 2-day period produced no nausea or vomiting. She had gained 2.6 lb and was eating normally. Urine examination revealed no evidence of protein or ketones; specific gravity was 1.005.
Acupuncture treatment of PC 6 was repeated. The patient was advised to discontinue the acupressure and ginger treatment. A follow-up visit 2 weeks later revealed the complete absence of nausea and vomiting. She continued normal prenatal care.
DISCUSSION
Prevention of nausea and vomiting in cases of cancer chemotherapy has been reported.12 Prolongation of such an antiemetic effect is reported by combining acupuncture with acupressure.13 Carlsson et al reported the reduction of nausea and vomiting of hyperemesis gravidarum in a placebo-controlled, randomized, single-blind, crossover study using PC 6 acupuncture.8 It is thus reasonable to expect a prolongation of prophylactic effect on nausea and vomiting of hyperemesis gravidarum when PC 6 acupuncture is combined with acupressure.
Ginger has been shown to enhance gastrointestinal motility.14 The antiemetic effect of ginger was similar to the drug metoclopramide in a placebo-controlled, double-blind study.15 In another double-blind, randomized, crossover trial, ginger was found to reduce the severity and frequency of nausea and vomiting in 19 of 27 cases of hyperemesis gravidarum.16
This patient was treated with all 3 modalities to achieve the maximum beneficial effect. Combining modalities, however, makes it difficult to determine if symptom improvement was due to the specific effect of a single modality or the cumulative effect of multiple modalities.
CONCLUSIONS
Although it is difficult to draw conclusions from a single case, it is reasonable to suggest that such TCM modalities should be used and scientifically tested in larger studies. Reporting cases such as this may lead to large prospective studies evaluating ginger, acupuncture, and acupressure in the management of hyperemesis gravidarum.
REFERENCES
- Klebanoff MA, Koslowe PA, Kaslow R, Rhoads GG. Epidemiology of vomiting in early pregnancy. Obstet Gynecol. 1985;66:612-616.
- Godsey RK, Newman RB. Hyperemesis gravidarum: a comparison of single and multiple admissions. J Reprod Med. 1991;36:287-290.
- Goodwin TM, Hershman JM, Cole L. Increased concentration of the free beta-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstet Gynecol Scand. 1994;73:770-772.
- van de Ven CJM. Nasogastric enteral feeding in hyperemesis gravidarum. Lancet. 1997;349:445-446.
- Frigo P, Lang C, Reisenberger K, Kolbl H, Hirschl AM. Hyperemesis gravidarum associated with Helicobacter pylori seropositivity. Obstet Gynecol. 1998;91:615-617.
- Belluomini J, Litt RC, Lee KA, Katz M. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol. 1994;84:245-248.
- Hyde E. Acupressure therapy for morning sickness: a controlled clinical trial. J Nurse Midwifery. 1989;34:171-178.
- Carlsson CP, Axemo P, Bodin A, et al. Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage. 2000;20:273-279.
- Ellis AW, Wiseman NA, Boss K. Fundamentals of Chinese Acupuncture. Rev ed. Brookline, MA: Paradigm Publications; 1991.
- Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, CA: Medical Acupuncture Publishers; 1995.
- NIH Consensus Conference. Acupuncture. JAMA. 1998;280:1518-1524.
- Dundee JW, Ghaly RG, Fitzpatrick KT, Abram WP, Lynch GA. Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J R Soc Med. 1989; 82:268-271.
- Dundee JW, Yang J. Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J R Soc Med. 1990;83:360-362.
- Yamahara J, Huang QR, Li YH, Xu L, Fujimura H. Gastrointestinal motility enhancing effect of ginger and its active constituents. Chem Pharm Bull (Tokyo). 1990;38:430-431.
- Bone ME, Wilkinson DJ, Young JR, McNeil J, Charlton S. Ginger root: a new antiemetic-the effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia. 1990;45:669-671.
- Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 1991;38:19-24.
AUTHORS' INFORMATION
Dr Abraham C. Kuruvilla is Board-certified in Family Practice, Pediatrics, and Neonatal-Perinatal Medicine, and practices in Guadalupe, Arizona.
Abraham C. Kuruvilla, MD*
5825 E. Calle Guadalupe
Guadalupe, AZ 85283
Phone: 480-344-6000 • Fax: 480-344-6001 • E-mail: Abraham.Kuruvilla@hcs.maricopa.gov
Dr Molly Kresin is Board-certified in Family Practice, and practices in Guadalupe, Arizona.
Molly Kresin, DO
E-mail: molly.kresin@hcs.maricopa.gov
*Correspondence and reprint requests
|
