Material and method: Ninety-eight volunteer pregnant women with symptoms of nausea and vomiting in early pregnancy before 14 weeks gestation were enrolled. The participants were randomized into two groups: treatment group and control group. Each patient in the treatment group received magnet pellets, placed at both auricles. They were taught to start acupressure from the third to the sixth day. Outcome measurement was Rhodes index score, which describe the severity and frequency of nausea and vomiting in the form of a questionnaire. The patients from both groups were asked to complete and return the forms including the amount of anti-emetic drug taken. Mean Rhodes index score and total number of anti-emetic drug taken from day 4-6 were used to compare the treatment effect. Student's t test, Chi-square test and Mann-Whitney U test were used for statistical analysis.
acupressure for the inpatient treatment of nausea and vomiting in early pregnancy a randomized contr
Results: Ninety-one pregnant women who returned the questionnaires were evaluated. The Rhodes index scores of the treatment group were lower than that of the control group especially after day 4 to day 6 when the acupressure was started. However when comparing the mean score between the two groups, there were no statistically significant differences (p > 0.05). The total amount of anti-emetic tablets in day 4-6 after acupressure intervention was compared and there were no statistically significant differences (p > 0.05) between the groups.
Conclusion: Auricular acupressure therapy in treatment of nausea and vomiting in early pregnancy may not relieve nausea and vomiting in early pregnancy and need further clinical research to confirm the effectiveness.
The application of acupressure at the P6 (Nei Guan) meridian point is known to treat vomiting and other stomach problems in the practice of traditional Chinese medicine. Dundee et al. first revealed that acupuncture or acupressure at the P6 meridian point was as effective as the standard antiemetic in treating nausea and vomiting [8,9,10]. P6 (Nei Guan) is the sixth meridian point in the pericardium channel of Hand Jueyin, which is located on the anterior surface of the forearm about 2 inches proximal to the distal wrist crease between the tendons of the musculus flexor carpi radialis and musculus palmaris longus [11,12,13].
Acupressure and acupuncture are generally similar, except that the latter requires the use of needles. The special composition of blood vessels, mast cells, and nerve fibers at acupoints enables them to be easily activated for the mediation of acupuncture signals [14]. The mechanism of acupressure at the P6 point to prevent nausea and vomiting is not yet fully understood. It was found that acupuncture stimulated the release of β endorphins into the cerebrospinal fluid [15], thereby increasing the endogenous antiemetic tone [16]. The application of acupuncture has also been linked to the biological effects exerted by neurohumoral factors, neurotransmitters, and other chemical mediators in the nervous system for pain modulation [17].
Our findings echo a previous double-blinded trial that concluded a significant reduction in nausea, vomiting severity, and ketonuria when acupressure was used as an adjunct treatment to the existing standards of care for hyperemesis gravidarum in low-risk pregnancy [26]. A newer trial was also of the opinion that acupressure at the P6 point could apparently reduce the intensity of nausea and vomiting in pregnant women [27]. A recent network meta-analysis showed that acupressure was associated with better control of hyperemesis gravidarum symptoms than standard care and, at the same time, decreased the need for rescue antiemetics [28]. The quality of evidence in this meta-analysis was, however, very low. In contrast, a Cochrane review demonstrated insufficient high-quality evidence in ascertaining the efficacy of acupressure as an alternative to minimize the severity of nausea and vomiting in early gestation up to 20 weeks [29]. Another Cochrane review that exclusively included hyperemesis gravidarum patients reported an absence of trials that study the effects of P6 acupressure on nausea and vomiting in hyperemesis gravidarum patients [30]. Apart from recommending a consistent definition of hyperemesis gravidarum [30], two Cochrane reviews concomitantly highlighted the necessity to adopt standardized, justified outcome measurements [29,30].
Background: Two-thirds of pregnant women experience nausea and vomiting during early pregnancy. The use of pharmacological drugs to alleviate this condition does not reduce nausea and vomiting to the desired extent.
Results: In the present study, acupressure applied to the participants in the acupressure group very significantly reduced nausea and vomiting (Before intervention 7 vs. After intervention 4) compared to the control group (Before intervention 7 vs. After intervention 8, P
Conclusions: Statistical results have provided that acupressure taught to women was found to be highly effective in reducing pregnancy-induced nausea and vomiting. Teaching pregnant women how to perform acupressure on their own will be an alternative method especially for women who do not want to use pharmacological methods in the first trimester of their pregnancy.
Heitmann et al. in a review study reported that the risk of congenital malformations, stillbirth / perinatal death, preterm birth, low birth weight, or low Apgar score did not increase when ginger was used during pregnancy (21). Therefore, a safe and effective treatment choice for NVP is ginger (22). The use of ginger products may be helpful to relieve nausea and vomiting, but the evidence of effectiveness was limited (23).
Women were excluded if they were unable to return for a follow-up visit one week later, had complications when using ginger or wristbands, the advised method for treatment failed to relieve nausea and vomiting, and NVP was progressing to severe (> 5 episodes per day).
After obtaining verbal informed consent, women underwent general physical examinations and routine obstetric evaluations. They were subsequently randomized into three groups (ginger, acupressure and control) using a table of random numbers.
At first, the demographic form including age, age of marriage, gestational age, occupation, parity, wanted or unwanted pregnancy and education was completed. Women were instructed not to take any other medications except the treatment advised by the researchers. Women were followed for 7 days. They did not receive any intervention for the first three days but interventions were performed for the acupressure and ginger groups for the next four days. All women in the three groups were instructed to go on diet during the study [split their meals into frequent small ones, rich in carbohydrates and low fat. Also avoiding or not to eat food that may actually make nausea worse, try eating before or as soon as you feel hungry, stop smoking, eat dry bread or cookie on awaking, avoiding fried, odorous, spicy, greasy, or gas forming foods, maintaining good posture, drinking cold, clear, and carbonated or sour fluids (27)].
The hypothesis tested whether ginger and acupressure were different in reduce nausea, vomiting and retching symptoms. These were indicated by mean difference Rhodes index scores between the three groups by ANOVA test. It was calculated by mean Rhodes index scores in four days after the intervention (post intervention) minus in three days before the intervention (pre intervention).
We compared the mean difference Rhodes index scores between the three groups. The mean difference Rhodes index scores calculated by mean Rhodes index scores in pre intervention (three days before intervention) minus mean Rhodes index scores in post intervention (four days after intervention). It was significantly greater in ginger group than acupressure and control groups. ANOVA test showed that there were significant differences in the mean differences in vomiting, nausea, retching and total scores between the three groups (P
Paired t-test was also used to compare the mean pre and post intervention scores. Results indicated that there were significant differences in the mean pre and post intervention in ginger and acupressure groups. No significant differences were found apart from vomiting in control group (Table 2).
Tukey post hoc test was performed and the results showed that the mean differences in vomiting, nausea, retching, and total scores between the groups were significantly different except for vomiting score between acupressure and control groups (P = 0.98), and retching score between acupressure and ginger groups (P = 0.29).
Results in this trial showed that ginger was effective in treating nausea, vomiting and retching. In Ozgoli et al. study, the experimental group received 250 mg capsules of ginger, 4 times a day for 4 days, and the control group took placebo with the similar prescription form. They found that ginger was an effective herbal therapy for relieving nausea and vomiting, and an improvement in nausea symptoms during pregnancy was reported by the most of pregnant women in the ginger group (13). In a randomized controlled study, intervention group took 1 g/day for 4 days. In that trial, an improvement in nausea symptoms was reported by 82.8% of women in the ginger group (20). However, the results in the present study showed that vomiting and nausea in the ginger group decreased 52% and 48% respectively. This may take place due to the lower ginger dose in our study (750 mg/day versus 1 g/day).
In addition, randomized studies results have shown statistically significant effects of acupressure in the treatment of nausea, vomiting, and retching symptoms (P 2ff7e9595c
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