Examining the Predictors of Postoperative Nausea and Vomiting in Women Following Cesarean Delivery

Objective: Postoperative nausea and vomiting (PONV) is a common complaint of women who receive intrathecal morphine for analgesia during cesarean delivery. There is a paucity of evidence to support implementation of strategies to reduce PONV and minimize the negative outcomes associated with PONV following cesarean delivery. The study aimed to answer the following research questions: 1) What is the incidence and severity of PONV for women during the 24 hour period following surgery; 2) What are the relationships between socio-demographics, OB-GYN history, and antiemetic received (e.g. type(s), timing, and frequency) and incidence and severity of PONV; and 3) Does the timing, type, and frequency of anti-emetic use predict the incidence and severity of PONV when other known predictors are considered?

Design: Retrospective descriptive correlational design

Setting: A 600-bed community hospital in Southern California

Sample: Sixty women - Caucasians (61.7%), African-American (1.7%), Hispanics (11.7%), Asians (18.3%) and non-specified (6.6%) – who had cesarean delivery.

Methods: Information related to sociodemographic characteristics, medical and OB-GYN history, treatment received during cesarean delivery, incidence and severity of post-operative nausea and vomiting, and treatment measures received and outcomes were abstracted from the medical records following receipt of Institutional Review Board approval to conduct the study.

Results: Thirty women (50%) complained of PONV during the 24 hour period after surgery. The use of antiemetic during and after surgery immediately, and the use of multimodal vs. single therapy were associated with decreased incidence and severity of PONV (p <  .001 and  p =  .018, respectively). In a mutilvariate model, these two variables were accounted 48% of the variance in PONV while age, type of anesthesia used, history of PONV, and gravidity and parity were controlled for.

Conclusion/Implications for nursing practice: Findings show that the use of multimodal anti-emetics during and after cesarean delivery immediately reduces the incidence and severity of PONV. Prospective studies examining the predictors of PONV in women after cesarean delivery are warranted to better explain this phenomenon and to guide clinical nurses into the development of policies and pathways to help reduce PONV in specified population in women health and to collaborate mother-baby care with other health care providers.

Keywords: Post-operative nausea and vomiting, cesarean delivery, antiemetic, multimodal