OBJECTIVE: To review available evidence about the effectiveness of alternative therapies for nausea and vomiting of pregnancy. DATA SOURCES: MEDLINE and 13 additional US and international data bases were searched in 1996-1997 for papers that described use of alternative medicine in the treatment of pregnancy and pregnancy complications, specifically those addressing nausea, vomiting, and hyperemesis. Bibliographies of retrieved papers were reviewed to identify additional sources. METHODS OF STUDY SELECTION: All relevant English language clinical research papers were reviewed. Randomized clinical trials addressing specifically the use of nonpharmaceutical and nondietary interventions were chosen for detailed review. TABULATION, INTEGRATION, AND RESULTS: Ten randomized trials studying the effects of acupressure, ginger, and pyridoxine on nausea and vomiting of pregnancy were reviewed. Evidence of beneficial effects was found for these three interventions, although the data on acupressure are equivocal. Insufficient evidence was found for the benefits of hypnosis. Other interventions have not been studied. CONCLUSION: There is a dearth of research to support or to refute the efficacy of a number of common remedies for nausea and vomiting of pregnancy. The best-studied alternative remedy is acupressure, which may afford relief to many women; ginger and vitamin B6 also may be beneficial.

Pregnancy Nausea Alternative therapies nausea vomiting Obstetrics & Gynecology Review international data bases hyperemesis Randomized clinical trials nonpharmaceutical nondietary acupressure ginger pyridoxine vitamin B6 randomized trials abstract negative AMTA Foundation Medline PubMed NLM Columbia University College of Physicians and Surgeons Non-Specific Massage Acupressure Professional Ginger Vitamin B6 Hypnosis Adults Female Pregnancy undefined Acupressure, Alternative Medicine, Alternative Medicine/mt [Methods], Alternative Therapies, Clinical, clinical research, Clinical Trial, Clinical Trials, Complementary, Complication, Complications, Data, Data Base, Department, effect, effectiveness, effects, Efficacy, Female, Gynecology, Health, Healthstar, Human, Hypnosis, Intervention, Language, Medicine, MEDLINE, Methods, Nausea, Nausea and Vomiting, Nausea/th [Therapy], New York, Obstetrics, Physician, Physicians, Pregnancy, Pregnancy Complications, Pyridoxine/tu [Therapeutic Use], Randomized trial, Remedies, Research, Review, Support, Support,U.S.Gov't,P.H.S., Therapies, Therapy, Treatment, Trial, Trials, Use, Vomiting, Vomiting/th [Therapy], Women, Women's Health, Zingiberales/tu [Therapeutic Use]

BACKGROUND: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the "true" and placebo effect of acupressure in prevention of postoperative nausea and vomiting (PONV). PATIENTS AND METHODS: Sixty women undergoing outpatient minor gynaecological surgery were entered into a double-blind and randomised study. One group received acupressure with bilateral stimulation of P6 (A), a second group received bilateral placebo stimulation (P) and a third group received no acupressure wrist band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. In addition, the need for rescue antiemetic medication and nausea after 24 h was registered. RESULTS: Complete response was obtained in 11, 11 and 9 patients in groups, A, P and R, respectively. Nine, 7 and 6 patients had nausea before discharge home, and 1, 1 and 8 patients were nauseated (8 vs 1 patient: P < 0.05) 24 h after operation in A, P and R groups, respectively. When compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly (P < 0.05) fewer needed rescue antiemetic medication after acupressure at P6 (no vomiting or rescue medication). When compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited after acupressure (P < 0.05) CONCLUSION: In patients undergoing brief gynaecological surgery, placebo effect of acupressure decreased nausea after 24 h but vomiting and need of rescue antiemetics was reduced only by acupressure with the correct P6 point stimulation.

Acupressure P6 Nausea Vomiting outpatient gynaecological surgery Acta Anaesthesiologica Scandinavica Technique foreign Swedish Acupressure Acupuncture antiemetic effect true effect placebo effect postoperative nausea postoperative vomiting PONV minor gynaecological surgery double-blind randomised bilateral stimulation P6 bilateral placebo stimulation no acupressure wrist band reference group rescue antiemetic medication abstract positive AMTA Foundation Medline PubMed NLM University Hospital in Linkoping, Sweden Massage Acupressure Professional non-specific Adults Female Nausea/Vomiting Gynaecological Diseases behavior Postoperative Nausea (-) Postoperative Vomiting (-) Antiemetic Medication (-) Acupressure, Acupuncture, Adolescence, Adult, Ambulatory Surgical Procedures, Antiemetics, Article, Care, Clinical, Clinical Trial, Controlled trial, Department, Double-blind, Double-Blind Method, effect, Female, Gynecologic Surgical Procedures, Home, Hospital, Human, Inpatient, Intensive Care, Methods, Middle Age, Nausea, Nausea and Vomiting, Need, Patient, Patients, placebo, Placebo Effect, Point, Postoperative, Postoperative nausea, Postoperative Nausea and Vomiting, Postoperative Nausea and Vomiting/dt [Drug Therapy], Postoperative Nausea and Vomiting/th [Therapy], Prevention, Randomized controlled trial, Stimulation, Surgery, Sweden, Trial, Vomiting, Women, Wrist

We studied the effect of P6 acupressure on 46 women undergoing laparotomy for major gynaecological surgery who received patient-controlled analgesia. Half the patients received acupressure at the P6 site, the remainder received acupressure at a "sham" site. There was a reduction in the requests for anti-emetic therapy in the group receiving P6 acupressure but there was no difference in the incidence of nausea and vomiting. There was no difference in total morphine consumption between the two groups.

Post Surgical Massage (Gynaecological) P6 acupressure nausea vomiting gynaecological surgery Anaesthesia & Intensive Care Disease Post Surgical women patient-controlled analgesia sham" site morphine consumption AMTA Foundation Medline PubMed NLM abstract positive Department of Anaesthesia, Northampton General Hospital, England Massage Acupressure Professional Non-Specific Adults Female Nausea/Vomiting Endometriosis Laparotomy lab behavior Morphine Consumption (0) Antiemetic Medication (-) Postoperative Nausea (0) Postoperative Vomiting (0) Acupressure, Acupuncture Points, Acupuncture Therapy, Adolescence, Adult, Aged, Anaesthesia, Analgesia, Analgesia,Patient-Controlled, Department, effect, effects, England, Female, Genitalia,Female/su [Surgery], Healthstar, Hospital, Human, Incidence, Laparotomy, Laparotomy/ae [Adverse Effects], Middle Age, Morphine, Morphine/ad [Administration & Dosage], Nausea, Nausea and Vomiting, Nausea/pc [Prevention & Control], P6 acupressure, Patient, Patients, Postoperative Complications/pc [Prevention & Control], Pressure, Prochlorperazine/ad [Administration & Dosage], Prochlorperazine/tu [Therapeutic Use], Surgery, Therapies, Therapy, Vomiting, Vomiting/pc [Prevention & Control], Women, Wrist

The application of acupuncture, moxibustion, acupressure, and shiatsu to antepartal and intrapartal care are discussed. Information on therapeutic interventions as described in textbooks is presented and compared with specific treatments evaluated in research studies. Specific clinical indications addressed include nausea during pregnancy, repositioning of the fetus in breech position, stimulation of contractions and true labor, and pain relief in labor. Qualifications for practitioners and recommendations for certified nurse-midwives caring for clients seeking referral for these services are discussed.

Acupuncture treatment modalities antepartal care intrapartal care Journal of Nurse-Midwifery Technique Acupuncture & Related Treatment nausea pregnancy fetal repositioning breech position contractions true labor pain relief practitioner qualifications certified nurse-midwives abstract variables-? results-? AMTA Foundation Medline PubMed NLM ale University School of Nursing, New Haven, CT Acupuncture Non-Specific Unknown Massage Acupressure Massage Shiatsu Acupuncture Moxibustion Pregnancy Labor Pain undefined Acupressure, Acupuncture, Acupuncture Therapy/mt [Methods], Acupuncture Therapy/st [Standards], Care, Caring, Clients, Clinical, Contractions, Ct, Female, Fetus, Healthstar, Human, ii, Indications, Information, Intervention, Labor, Labor/ph [Physiology], Moxibustion, Nausea, Nurse Midwives, Nursing, Pain, Pain relief, Practitioner, Practitioners, Pregnancy, Prenatal Care/mt [Methods], Research, shiatsu, Stimulation, Therapeutic, Treatment

OBJECTIVE: To evaluate the effectiveness of acupressure in reducing nausea and vomiting of pregnancy. METHODS: Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using an acupressure point (PC-6) and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive days, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 days were used as pre-treatment scores. Beginning on the morning of the fourth day, each subject used acupressure at her assigned point for 10 minutes four times a day. Data from day 4 were discarded to allow 24 hours for the treatment to take effect. Data from days 5-7 were used to measure treatment effect. RESULTS: Sixty women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58 = 10.4, P = .0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r = 0.261, P = .044) between maternal age and severity of nausea. CONCLUSIONS: Our results indicate that acupressure at the PC-6 anatomical site is effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women.

Nausea Vomiting Acupressure pregnancy randomized blinded study Obstetrics & Gynecology PC-6 sham control group placebo point blind pre-treatment scores attrition parity fetal number maternal age gestational age pre-treatment nausea emesis scores Analysis of variance ANOVA treatment group control group sham control group severity positive correlation maternal age anatomical site abstract positive AMTA Foundation Medline PubMed NLM Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco Day=10 Minutes=4x=10 days weeks Massage Acupressure NonProfessional Self Massage frequency Adults Female Pregnant count Pregnancy Nausea/Vomiting task/test ADL Assessment Scale Nausea/Vomiting (-) Vomiting Frequency (0) Acupressure, Acupuncture Points, Acupuncture Therapy/mt [Methods], Adult, Age, Analysis of Variance, Article, Blind, California, Clinical, Clinical Trial, Control Group, Controlled trial, Data, Department, Double-Blind Method, effect, effectiveness, Emesis, Female, Follow-Up Studies, Gestational Age, Gynecology, Human, Incidence, Massage/mt [Methods], Maternal Age, Medical, Methods, Nausea, Nausea and Vomiting, Nausea/ep [Epidemiology], Nausea/th [Therapy], Obstetrics, Parity, placebo, Point, Pregnancy, Pregnancy Complications/ep [Epidemiology], Pregnancy Complications/th [Therapy], Pressure, Randomized controlled trial, Reproducibility of Results, San Francisco, Score, Severity of Illness Index, Support,Non-U.S.Gov't, Symptom, Symptoms, Treatment, Treatment Outcome, Trial, Vomiting, Vomiting/ep [Epidemiology], Vomiting/th [Therapy], Women, Wrist

Complementary and alternative medicine (CAM) therapies are widely used in the general population. This paper reviews randomized controlled trials of CAM therapies for obstetrical and gynecologic conditions and presents therapies that are likely to be used by women of reproductive age and by pregnant women. DATA SOURCES: Sources included English-language papers in MEDLINE 1966-2002 and AMED (1985-2000) and the authors' extensive holdings. STUDY SELECTION: Randomized controlled clinical trials of CAM therapies for obstetric and gynecologic conditions. DATA EXTRACTION: Clinical information was extracted from the articles and summarized in tabular form or in the text.DATA SYNTHESIS: Ninety-three trials were identified, 45 of which were for pregnancy-related conditions, 33 of which were for premenstrual syndrome, and 13 of which were for dysmenorrhea. Data support the use of acupressure for nausea of pregnancy and calcium for PMS. Preliminary studies indicate a role for further research on Vitamin B6 or ginger for nausea and vomiting of pregnancy; calcium, magnesium, Vitamin B6, or chaste-tree berry extract for PMS; and a low-fat diet, exercise, or fish oil supplementation for dysmenorrhea. CONCLUSIONS: Limited evidence supports the efficacy of some CAM therapies. Exposure of women of reproductive age to these therapies can be expected.

Acupressure nausea Pregnancy Complementary alternative medicine CAM reproductive-age women review randomized controlled trials Acupressure gynecologic pregnant English-language papers premenstrual syndrome pms dysmenorrhea nausea calcium Vitamin B6 chaste-tree berry extract low-fat diet exercise fish oil supplementation abstract variables-? results-? AMTA Foundation Medline PubMed NLM Massage Acupressure Professional Alternate Systemic Therapies Adults Female Occupation Unknown Gynaecological Diseases Obstetrical Diseases undefined

We review the published literature examining the efficacy of acupressure and acustimulation wrist bands for the relief of nausea, with special emphasis on the alleviation of nausea associated with pregnancy. We also present preliminary data from an open-label study on the efficacy of acustimulation bands for control of chemotherapy nausea. The literature supports the conclusion that Neiguan-point stimulation by acupressure and acustimulation wrist bands for nausea relief is efficacious for many patients.

acustimulation bands nausea Am J Obstet Gynecol (Suppl Understanding) Neiguan-point stimulation Review acupressure wrist bands open-label study acustimulation bands abstract variables-? positive AMTA Foundation Medline PubMed University of Rochester Cancer Center NY New York Non-Specific unknown Massage Acupressure Professional Acustimulation Wrist Bands Neiguan-Point Stimulation other Pregnancy Nausea/Vomiting Cancer Chemotherapy Nausea undefined Acupressure, Acupuncture Therapy, Female, Human, Nausea/th [Therapy], Pregnancy, Support,Non-U.S.Gov't, Support,U.S.Gov't,Non-P.H.S., Vomiting/th [Therapy]

Although stimulation of certain acupressure points for long has been claimed to alleviate nausea, previous research has left contradictory results. The aim of our study was to find out if acupressure can alleviate nausea and vomiting in early pregnancy. MATERIAL AND METHODS: 97 women with mean gestational length between 8 and 12 weeks were randomized to use either active acupressure or placebo acupressure bands. Symptoms were recorded before they entered the study, during the use of the wristbands, and after the end of the study, according to the intensity, duration and nature of complaints. RESULTS: 71% of the women in the intervention group reported both less intensive morning sickness and shorter duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms, However, significance levels of 5% were reached regarding duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.0018). INTERPRETATION: Acupressure wristband might be an alternative for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered

Acupressure Morning Sickness Tidsskr Nor Laegeforen Technique Acupressure foreign Norwegian acupressure points early pregnancy women mean gestational length randomized active acupressure bands placebo acupressure bands wristbands intensity duration and nature complaints morning sicknessplacebo group compare treatment No Treatment evaluation abstract positive Medline PubMed NLM Farmasibygget Universitetet i Tromso Acustimulation Wrist Bands Other Non-Specific Adults Female Pregnancy Nausea/Vomiting ADL Nausea

Nausea and vomiting are uncomfortable and some times debilitating symptoms encoutered in early pregnancy. Many of the more conventional remedies offer only partial to negligible relief. Some pregnant women also express scepticism regarding the safety of the more traditionally prescribed pharmacological agents used to combat morning sickness. Vitabin B6, ginger root and acupressure are three complementary modalities that may help aleviate these self-limiting discomforts.

Acupressure for Nausea (Early Pregnancy) Complementary therapies vomiting Family Practice Review conventional remedies safety prescribed pharmacological agents morning sickness ginger root complementary modalities self-limiting discomforts abstract positive AMTA Foundation Medline PubMed NLM State University of New York Massage Acupressure Professional Vitamin B6 Ginger Other Non-Specific Adults Female Nausea/Vomiting adl Nausea