This study was funded by a grant from the Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine.

All procedures of this study were conducted by clinical trial registration and were approved by the ethical institution of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Filing No. 2022SL-015). All patients in this study were fully provided with informed consent and consented to the investigators&#39; use of data, images, and related video filming during the trial. Eligible patients were recruited (from January 2023 to April 2023) through leaflets, word communication, and doctors&#39; recommendation in the inpatient department of the Hospital of Chengdu University of Traditional Chinese Medicine.
1. Patient selection
<ol>
	<li>Inclusion criteria
	<ol>
		<li>Confirm intrauterine pregnancy. Identify early pregnancy vomiting as the main complaint, referring to the Guidelines for the Diagnosis and Management of NVP published by the American College of Physicians in 201810, and ensure that the participants meet the diagnostic criteria for clinical NVP.</li>
		<li>Verify that participants are not currently participating in other clinical trials.</li>
	</ol>
	</li>
	<li>Exclusion criteria
	<ol>
		<li>Exclude individuals with other pathological conditions causing NVP, such as hyperemesis gravidarum, pregnancy-associated viral hepatitis, or pregnancy-associated acute gastroenteritis.</li>
		<li>Exclude participants who refuse treatment with ear plaster therapy.</li>
		<li>Exclude individuals with severe NVP or allergies to the medication or its excipients and participants with auricular injuries.</li>
		<li>Exclude those who have been treated for NVP within the last 2 weeks.</li>
	</ol>
	</li>
	<li>Disposal of dropout cases
	<ol>
		<li>Withdraw participants from the trial if they are unable to sustain adherence to the treatment. Allow participants to voluntarily withdraw from the study if they choose to do so.</li>
	</ol>
	</li>
	<li>Criteria for termination of the trial
	<ol>
		<li>Terminate the participants who develop serious complications or experience disease progression during the study. Cease the trial if participants develop serious adverse reactions.</li>
	</ol>
	</li>
</ol>
2. Patient grouping and treatment plan
<ol>
	<li>Recruit twenty patients and randomly assign them to either the experimental group or the control group.</li>
	<li>Provide the control group with a controlled diet and administer conventional treatment, including rehydration and vitamin supplementation (see Results section for details).</li>
	<li>For the experimental group, administer ear plaster therapy in addition to conventional treatment.</li>
	<li>Ensure that the rest management for both groups remains the same until the patients are discharged from the hospital.</li>
</ol>
3. Preparation for ear plaster therapy procedure
<ol>
	<li>Gather the necessary items (Figure 1): scissors, sterile cotton swabs, tweezers, medical tape, 75% alcohol, and cowherb seeds (see Table of Materials).</li>
	<li>Preparation of the ear plaster
	<ol>
		<li>Cut the adhesive tape into square pieces measuring 0.6 cm x 0.6 cm.</li>
		<li>Take 1 or 2 smooth cowherb seeds (seeds of B. Wang, obtained from a pharmaceutical company, see Table of Materials) and place them at the center of each tape square, as shown in Figure 2.</li>
	</ol>
	</li>
	<li>Patient preparation
	<ol>
		<li>Instruct the patient to sit in a comfortable position.</li>
		<li>Inspect the condition of the skin on the ear. 
		NOTE: Ensure that the skin of the ear is intact and free from any abnormalities (e.g., inflammation, ulceration, frostbite, etc.) before proceeding with the treatment. Ear plaster therapy should not be performed on areas with auricular trauma or inflammation. It should only be carried out after these abnormalities have subsided and the trauma has healed. If the patient is allergic to adhesive tape, use alternative materials.</li>
	</ol>
	</li>
	<li>Selection of acupoints
	<ol>
		<li>Locate points/sensitive areas on the ear. Stabilize the ear auricle by using the thumb and index finger of one hand to pinch and lift the ear helix backwards and upwards, fully exposing the area.</li>
		<li>With the sterile swab in the other hand, gently probe the patient&#39;s ear to identify sensitive pressure points near the six auricular points of the stomach (CO4), cardia (CO3), belly (AH8), shenmen (TF4), subcortex (AT4), and liver (CO12) (Figure 3). 
		NOTE: Sensitive points refer to areas where there is significant soreness, numbness, swelling, or pain compared to other areas when applying pressure. These sensitive points have demonstrated better therapeutic effects compared to other common auricular points7. Based on previous clinical studies, the six auricular points (CO4, CO3, AH8, TF4, AT4, and CO12) are commonly used in the treatment of NVP and have prominent antiemetic and calming effects11,12,13. If sensitive points on the ear are not detected, the six mentioned points can be selected for the subsequent treatment round.</li>
	</ol>
	</li>
	<li>Disinfection
	<ol>
		<li>Disinfect the hands of the operator using an alcohol-soaked cotton ball.</li>
		<li>Disinfect the patient&#39;s auricle using a sterile cotton swab dipped in 75% alcohol. 
		&#8203;NOTE: The disinfection area should cover approximately 1-2 cm&#178; of the auricular skin surrounding the target point. Alcohol helps remove oil from the skin surface, ensuring better adhesive properties of the tape. If the patient is allergic to alcohol, iodophor can be used as an alternative.</li>
	</ol>
	</li>
</ol>
4. Ear plaster therapy
<ol>
	<li>Once the area is dry, stabilize the auricle by pinching the ear helix with the thumb and index finger of one hand, lifting it backward and upward.</li>
	<li>Using forceps, take the prepared ear plaster (step 3.2) and place the central seeds of the cowherb onto the selected point, as shown in Figure 4. Confirm with the patient that the seed placement corresponds to a sensitive point or sore area.</li>
	<li>Position the thumb and index finger in front of and behind the auricle, applying moderate and tolerable pressure with a rhythmic pressing and relaxing motion to stimulate the cowherb seeds at the auricular site. Press and release for 3-5 min at each site, maintaining an even rhythm. 
	NOTE: Adjust the intensity of pressure based on communication with the patient, ensuring that soreness, numbness, swelling, and pain are felt without excessive force.</li>
	<li>Monitor the patient&#39;s overall condition for 15 min following the treatment. 
	NOTE: In case of panic, chest distress, dizziness, or profuse sweating, promptly remove the adhesive tape.</li>
	<li>Instruct the patient or their family to rub the seeds three times a day: morning, midday, and evening. 
	NOTE: Emphasize the need for additional stimulation of the seeds when the patient experiences nausea.</li>
	<li>Remove the ear plaster after three days and repeat the above steps on the opposite ear, alternating treatment between the two ears. 
	&#8203;NOTE: Continue treatment until the patient meets the discharge criteria: PUQE score &#8804;4 and urinary ketone bodies turn negative. If the ear plaster becomes dislodged, reapply it.</li>
</ol>
5. Patient diagnosis
<ol>
	<li>Starting from the first day of hospitalization, collect fresh urine every 2 days to measure and record urinary ketone levels. Note the duration from the start of treatment to the time when the urinary ketone levels turn negative. 
	NOTE: Urinary ketone levels serve as an important indicator for assessing patients with NVP. A positive urine ketone level indicates ongoing starvation and dehydration14,15. Ensure timely testing of urine samples to prevent low values caused by ketone body evaporation.</li>
	<li>Instruct patients to complete the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale (see Table 1) on a daily basis. Record the scores based on their actual symptoms each day until the day of discharge. 
	&#8203;NOTE: The PUQE scale is widely used in various practice guidelines globally to measure the severity of NVP symptoms in patients16. A higher PUQE score indicates a more severe condition.</li>
</ol>
6. Post-operative care
<ol>
	<li>Advise the patient to keep the ear clean and dry. 
	NOTE: The placement of the seed patch does not interfere with daily activities such as washing and bathing.</li>
	<li>Provide reassurance and support to alleviate the patient&#39;s nervousness and fear.</li>
	<li>Instruct the patient to perform swallowing movements or take deep breaths when experiencing feelings of nausea and vomiting.</li>
	<li>If the patient experiences local allergic reactions such as itching, redness, or exudation on the skin during treatment, immediately remove the adhesive tape and apply anti-allergy ointment topically to alleviate these symptoms.</li>
	<li>If an infection occurs, manage it as a common infection. Use topical antibiotics (appropriate for pregnant women) or anti-inflammatory and analgesic ointments for treatment.</li>
	<li>Monitor the frequency and amount of vomiting, assess for signs of dehydration, and regularly measure urinary ketone levels. 
	NOTE: In cases where conditions affecting fetal development and maternal safety are present and cannot be effectively addressed, consider termination of the pregnancy.</li>
</ol>

Managing Gestational Vomiting with Ear Plaster Therapy

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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ltrogenic+Wernicke+ecepalpatly+in+a+patient+with+severe+hyperemesis+gravidarum.">ltrogenic Wernicke ecepalpatly in a patient with severe hyperemesis gravidarum.</a> Obstetrics &amp; Gynecology. 125, 1150-1152 (2015).</li><li>General Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China, National Standardization Administration of China. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> National Standard of the People's Republic of China (GB/T 13734 2008): Ear acupoint names and positioning [S]. , (2008).</li><li>Braude, D., Crandall, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ondansetron+versus+promethazine+to+treat+acute+undifferentiated+nausea+in+the+emergency+department:+a+randomized,+double-blind,+noninferiority+trial.">Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department: a randomized, double-blind, noninferiority trial.</a> Academic Emergency Medicine. 15, 209-215 (2008).</li><li>Deruelle, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expert+consensus+from+the+College+of+French+Gynecologists+and+Obstetricians:+Management+of+nausea+and+vomiting+of+pregnancy+and+hyperemesis+gravidarum.">Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum.</a> French College of Obstetricians and Gynecologists. S2468-7189 (22), 00261-002666 (2022).</li></ol>

The authors declare that they have no conflict of interest.

Nausea and vomiting in pregnancy (NVP) is a common condition that can pose risks to the health of pregnant women, even leading to complications despite terminating pregnancies. Clinical drugs often used for antiemetic/antinauseant effects, such as ondansetron and promethazine, carry potential risks for pregnant women, including dystonia, sedation, and lowered seizure thresholds22. Consequently, pharmacological treatments come with their own set of dangers. On the other hand, the symptom-centered treatments commonly employed today lack specificity and are sometimes ineffective23. Therefore, obstetricians should pay closer attention to this disorder.
This article introduces ear plaster therapy, a traditional Chinese medicine technique used for treating NVP. This therapy is simple, cost-effective, and safe, and has gained acceptance from patients in clinical practice. Our trial results also support the notion that when combined with conventional treatment, ear plaster therapy effectively alleviates NVP.
This article presents a retrospective clinical observation with limited patients and some limitations. However, it is believed that the effectiveness of ear plaster therapy will be fully demonstrated through randomized studies with larger sample sizes. Currently, several challenges are associated with using ear plaster therapy in NVP treatment. Firstly, the selection of ear points relies on the patients' subjective perceptions, which can lead to imprecise identification of sensitive points due to variations in patients' descriptions or perceptions. Secondly, there is a lack of quantitative indicators for the method, duration, and intensity of acupoint stimulation, and operators employ different techniques and levels of stimulation, potentially resulting in under or over-stimulation.
In our practice, we have observed that post-therapeutic care following this therapy is often overlooked. Post-operative care is crucial for treatment outcomes, prevention of complications, and patient satisfaction. The subcutaneous tissue of the ear is thin and contains numerous superficial blood vessels. Therefore, the use of adhesive tape and its removal can cause skin lesions or infection, necessitating careful handling. For this reason, specific post-operative care instructions are provided, including observing the skin of the auricle after treatment, maintaining cleanliness and dryness of the ear, and advising patients to avoid contact with liquids and contaminants on the day of needling. As nerve endings are widely distributed in the ear, some patients may experience pain when pressing the seeds. Treatment can proceed if the pain is tolerable and there is no harm to the ear. Furthermore, it is important to make adjustments based on post-operative assessments. If NVP relief is not sufficiently pronounced after two weeks of treatment, it may indicate inaccurately chosen ear acupuncture points, which should be adjusted by adding new points as needed.
Although the use of ear plaster therapy for NVP treatment is still being explored, the benefits demonstrated thus far are impressive. With accumulating clinical experience, we believe this therapy will increasingly prove effective in alleviating the pain experienced by pregnant women.

Nausea and vomiting during pregnancy (NVP) are common, affecting approximately 50%-80% of pregnant women to varying degrees1. When NVP progresses to moderate or severe levels, it increases the risk of adverse pregnancy outcomes for both the mother and the fetus. Therefore, early intervention for NVP may be beneficial in preventing the development of hyperemesis gravidarum2. The exact cause of NVP is not well understood in modern biomedicine, but it is believed to be associated with factors such as changes in the serum level of human chorionic gonadotropin during pregnancy and deficiencies of certain vitamins3. Current treatments for NVP include fasting, fluid infusion, and correction of electrolyte imbalances, but none of these approaches are considered reliable4. Consequently, finding an effective treatment that does not impact the development of the embryo or fetus is a significant clinical challenge.
Ear plaster therapy is a traditional Chinese medicine treatment method that involves the use of small, rounded objects, typically the seeds of cowherb, to stimulate specific points on the ear for disease prevention and treatment5. The dried and mature seeds of Vaccaria hispanica, also known as cowherb, are used in this therapy as they are believed to regulate blood and channels, enhance blood circulation, and promote lactation. The auricle (outer part of the ear) is rich in nerves, containing numerous acupuncture and sensitive points6. By stimulating these points, the soft tissues of the ear may produce localized aseptic inflammation, which in turn may regulate the neuroendocrine system, including the pituitary-adrenal cortex and sympathetic-adrenal cortical glands. Additionally, this therapy can potentially invigorate the body's non-specific immune response, leading to therapeutic effects7. Ear plaster therapy effectively treats NVP by targeting specific points on the ear that primarily regulate autonomic dysfunction, reduce gastrointestinal responses, and alleviate the sensation of vomiting. It can also increase the level of Motilin, a hormone that promotes intestinal motility8, and restore the appetite of pregnant women. Moreover, some previous studies suggest that ear plaster therapy may have a favorable impact on NVP-related mood disturbances9, as it exhibits similar actions to sedatives in relieving anxiety.
Ear plaster therapy is a simple and easily administered treatment method. It can be used in conjunction with conventional treatments to alleviate the symptoms of NVP while minimizing the potential risks associated with medication use for both the mother and the fetus. This protocol provides detailed instructions on how to perform this therapy and what to consider during the process. We hope ear plaster therapy will receive increased attention and be promoted and utilized in clinical practice.

<table><tbody><tr><td>Alcohol cotton ball</td><td>Yangzhou Longhu Medical Instrument Co., Ltd</td><td>20172142183</td><td></td></tr><tr><td>Cowherb seeds</td><td>Anhui Kangyunnuo Biotechnology Co., Ltd</td><td>SC10334161107893</td><td></td></tr><tr><td>Disposable tweezers</td><td>Yangzhou Guilong Medical Instrument Co., Ltd</td><td>20182010440</td><td></td></tr><tr><td>Glucose Injection</td><td>Jichuan Pharmaceutical Group Co., Ltd</td><td>H32024826</td><td></td></tr><tr><td>Omnifilm</td><td>Paul Hartmann AG</td><td>20210605</td><td></td></tr><tr><td>Potassium Aspartate and Magnesium Aspartate Injection</td><td>Hangzhou Minsheng Pharmaceutical Co., Ltd</td><td>H33020038</td><td></td></tr><tr><td>Potassium Chloride Injection</td><td>Shandong Qidu Pharmaceutical Co., Ltd</td><td>H20153283</td><td></td></tr><tr><td>Scissor</td><td>BERNAL DENTAS</td><td>20190961</td><td></td></tr><tr><td>Sodium Chloride Injection</td><td>Chenxin Pharmaceutical Co., Ltd</td><td>H20056758</td><td></td></tr><tr><td>Swab</td><td>Bicon,LLC</td><td>20151479</td><td></td></tr><tr><td>Vitamin B1 Injection</td><td>Chengdu Beite Pharmaceutical Co., Ltd</td><td>H32021525</td><td></td></tr><tr><td>Vitamin B6 Tablets</td><td>Gansu Chengji Biopharmaceutical Co., Ltd</td><td>H62020314</td><td></td></tr><tr><td>Vitamin C Tablets</td><td>Xinxiang Changle Pharmaceutical Co., Ltd</td><td>H41021516</td><td></td></tr></tbody></table>

ear plaster therapy as a safe and effective treatment for gestational vomiting

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as fasting, fluid infusion, and nutritional support are conventionally applied to manage NVP, their effectiveness varies. However, traditional ear plaster therapy offers a promising alternative that effectively relieves symptoms and poses no known risk to the development of embryos or fetuses. This therapy is known for its ease of application, cost-effectiveness, and favorable outcomes. Previous studies have demonstrated the efficacy of combining ear plaster therapy with conventional treatments in alleviating symptoms of nausea and vomiting in pregnant women, surpassing the results achieved with conventional treatment alone. The protocol presented herein describes a method to relieve NVP using round, smooth, and hard cowherb seeds applied to specific ear points. These seeds are gently rubbed onto the surface of the ear, utilizing the principles of acupressure. By stimulating the designated ear points, this procedure aims to regulate the body's energy flow and restore balance, thereby reducing the severity and frequency of NVP. The application of cowherb seeds on specific ear points is a straightforward technique that healthcare professionals can easily implement or self-administered by pregnant women under appropriate guidance. Overall, ear plaster therapy presents a safe, effective, and economical approach for managing gestational vomiting, offering women a potential solution to alleviate their discomfort during pregnancy.

All twenty participants in this clinical study successfully completed the trial. Four patients met the discharge criteria and were discharged on day 5, while the remaining 16 patients met the discharge criteria and were discharged within 2 weeks of hospitalization.
During the trial, the control group received a controlled diet and intravenous drips, which included the following components: vitamin C 2g + 0.9% sodium chloride injection 500 mL, vitamin B6 0.2 g + 0.9% sodium chloride injection 500 mL, potassium magnesium menadione 20 mL + 5% glucose injection 500 mL, potassium chloride 15 mL + glucose injection 500 mL, 0.9% sodium chloride injection 500 mL, and vitamin B1 200 mg (see Table of Materials) intramuscularly once daily. The amount of fluid infusion was gradually decreased when food intake increased10,17,18,19,20.
Patients in the experimental group received ear plaster therapy in addition to the same fluid infusion treatment as the control group until they were discharged. The duration of treatment, time to negative urine ketone bodies, and daily PUQE scores were analyzed. The measures were expressed as (x¯± s), and t-tests were used to compare the two groups.
Pregnancy-Unique Quantification of Emesis (PUQE) is used to measure the severity of nausea and vomiting during pregnancy (NVP) (Table 1). The total PUQE score is categorized as follows: Mild NVP with a score of ≤6, moderate NVP with a score of 7-12, and severe NVP with a score of ≥13.
The comparison of maternal age and gestational weeks between the two groups is presented in Table 2. The table indicates that there were no statistically significant differences in maternal age and gestational weeks between the two groups (p &gt; 0.05). The ages of the pregnant women and the duration of their pregnancies were similar in both groups.
Table 3 displays the comparison of hospitalization duration and the time taken for ketone bodies to turn negative between the two groups of pregnant women (x¯± s). The experimental group had a significantly shorter average hospital stay by 2.5 days compared to the control group. Similarly, the time for ketone bodies to turn negative was 2.4 days shorter in the experimental group. Both differences were statistically significant (p &lt; 0.05). These results suggest that ear plaster therapy can effectively reduce the treatment time for NVP.
The PUQE scores of the two groups of pregnant women are presented in Table 4. Prior to treatment, there were no statistically significant differences in PUQE scores between the groups (p &gt; 0.05). However, after five days of treatment, both the experimental and control groups showed a significant reduction in PUQE scores compared to their initial scores (p &lt; 0.05). In the experimental group, the mean PUQE score decreased from 12.6 to 5.0, while in the control group, it decreased from 12.5 to 6.9. Additionally, during the treatment period, the scores of the experimental group were consistently lower than those of the control group, and this difference was statistically significant (p &lt; 0.05). These findings suggest that the treatment was effective in both groups, with the experimental group demonstrating better efficacy than the control group.
<img alt="Surgical setup with scissors, swabs, tweezers, adhesive tape, disinfectant, and seeds; medical tools." class="xfigimg" src="/files/ftp_upload/65549/65549fig01.jpg" data-altupdatedat="1747911167000" data-alt="Figure 1"> 
Figure 1: The items required for ear acupuncture therapy. It includes various items: (A) Scissors, (B,C) Sterile cotton swabs and tweezers, (D) Medical tape, (E) 75% alcohol, and (F) Cowherb seeds. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Chromatography process; paper segment held in tweezers; ink spot sample; chemical analysis method." class="xfigimg" src="/files/ftp_upload/65549/65549fig02.jpg" data-altupdatedat="1747911167000" data-alt="Figure 2"> 
Figure 2: Prepared ear patches used in the treatment. The figure displays pictures of the ear patches that are utilized in the therapy. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Auricular acupuncture diagram showing ear acupoints for therapeutic use." class="xfigimg" src="/files/ftp_upload/65549/65549fig03.jpg" data-altupdatedat="1747911167000" data-alt="Figure 3"> 
Figure 3: The location of auricular points used in the treatment. The diagram is based on the National Standard of the People's Republic of China "Names and Positioning of Ear Points" (GB/T13734-2008)21. It highlights six specific ear points: stomach (CO4), cardia (CO3), belly (AH8), shenmen (TF4), subcortex (AT4), and liver (CO12). The diagram includes red circles to indicate the corresponding locations of these points. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Ear cleaning process diagram using cotton swab and tools for earwax removal, step-by-step guide." class="xfigimg" src="/files/ftp_upload/65549/65549fig04.jpg" data-altupdatedat="1747911167000" data-alt="Figure 4"> 
Figure 4: The key steps involved in the ear acupuncture procedure. The steps are as follows: (1) and (2) represent disinfection operations, (3) indicate probing for ear pressure points, (4), (5), and (6) represent the ear needling operations. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/65549/65549fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="5">Pregnancy-Unique Quantification of Emesis (PUQE)</td>
		</tr>
		<tr>
			<td colspan="5">Circle the answer that best fits your situation below</td>
		</tr>
		<tr>
			<td colspan="5">1. How long did you feel nauseous and vomit the day before?</td>
		</tr>
		<tr>
			<td>never</td>
			<td>≤1h</td>
			<td>2-3h</td>
			<td>4-6h</td>
			<td>≥6h</td>
		</tr>
		<tr>
			<td>1 point</td>
			<td>2 point</td>
			<td>3 point</td>
			<td>4 point</td>
			<td>5 point</td>
		</tr>
		<tr>
			<td colspan="5">2. How many times did you vomit the day before?</td>
		</tr>
		<tr>
			<td>never</td>
			<td>1-2 times</td>
			<td>3-4 times</td>
			<td>5-6 times</td>
			<td>≥7 times</td>
		</tr>
		<tr>
			<td>1 point</td>
			<td>2 point</td>
			<td>3 point</td>
			<td>4 point</td>
			<td>5 point</td>
		</tr>
		<tr>
			<td colspan="5">3. How many times did you dry heave the day before?</td>
		</tr>
		<tr>
			<td>never</td>
			<td>1-2 times</td>
			<td>3-4 times</td>
			<td>5-6 times</td>
			<td>≥7 times</td>
		</tr>
		<tr>
			<td>1 point</td>
			<td>2 point</td>
			<td>3 point</td>
			<td>4 point</td>
			<td>5 point</td>
		</tr>
	</tbody>
</table>
Table 1: Pregnancy-Unique Quantification of Emesis (PUQE) scoring system used to assess the severity of nausea and vomiting during pregnancy (NVP). The total score is categorized as follows: mild NVP with a score of ≤6, moderate NVP with a score of 7-12, and severe NVP with a score of ≥13.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Group A</td>
			<td>Group B</td>
			<td>n</td>
			<td>Age/year</td>
			<td>Gestational weeks/week</td>
		</tr>
		<tr>
			<td>Experimental group</td>
			<td>Experimental group</td>
			<td>10</td>
			<td>25.4 ± 1.57762</td>
			<td>7.9 ± 2.46982</td>
		</tr>
		<tr>
			<td>Control group</td>
			<td>Control group</td>
			<td>10</td>
			<td>25.5 ± 1.84089</td>
			<td>8.2 ± 1.98886</td>
		</tr>
	</tbody>
</table>
Table 2: Comparison of maternal age and gestational weeks between the two groups.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Group</td>
			<td>n</td>
			<td>Length of stay in hospital/day</td>
			<td>Time to negative ketone body/day</td>
		</tr>
		<tr>
			<td>Experimental group</td>
			<td>10</td>
			<td>6.2 ± 1.13529</td>
			<td>6.0 ± 0.94281</td>
		</tr>
		<tr>
			<td>Control group</td>
			<td>10</td>
			<td>8.7 ± 1.49443</td>
			<td>8.4 ± 1.50555</td>
		</tr>
	</tbody>
</table>
Table 3: Comparison of the duration of hospitalization and the time to turning negative of ketone bodies between the two groups of pregnant women. The average duration of hospitalization and the time taken for ketone bodies to turn negative are represented by x¯± s in Group A and Group B. x¯± s represents the mean and standard deviation values for the respective measurements in each group.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td rowspan="2">Group</td>
			<td rowspan="2">n</td>
			<td colspan="6">PUQE Score</td>
		</tr>
		<tr>
			<td>Before treatment</td>
			<td>Treatment day 1</td>
			<td>Treatment day 2</td>
			<td>Treatment day 3</td>
			<td>Treatment day 4</td>
			<td>Treatment day 5</td>
		</tr>
		<tr>
			<td>Experimental group</td>
			<td>10</td>
			<td>12.6 ± 0.84327</td>
			<td>9.7 ± 0.82327</td>
			<td>8.6 ± 1.17379</td>
			<td>7.0 ± 1.26930</td>
			<td>5.9 ± 1.44914</td>
			<td>5.0 ± 1.69967</td>
		</tr>
		<tr>
			<td>Control group</td>
			<td>10</td>
			<td>12.5 ± 0.84984</td>
			<td>10.9  ± 1.10050</td>
			<td>10.0 ± 1.41421</td>
			<td>9.0 ± 1.41421</td>
			<td>8.1 ± 1.52388</td>
			<td>6.9 ± 1.19722</td>
		</tr>
	</tbody>
</table>
Table 4: Comparison of PUQE scores between the two groups of pregnant women. The average PUQE scores are represented by x¯± s in Group A and Group B. x¯± s represents the mean and standard deviation values for the respective measurements in each group.

Watch this Scientific Journal Video about Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture at JoVE.com

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture 

The presented protocol describes a traditional Chinese medicine treatment procedure known for its safety and effectiveness in managing gestational vomiting.

Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as ...

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Nanyang Technological University

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Unit 1

Drugs for Nausea and Vomiting

SCIENTISTS IN ACTION

1.2K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. Ons onderzoek is gericht op het ontwikkelen van effectieve behandelingen voor misselijkheid en braken tijdens de zwangerschap. We willen manieren onderzoeken om het symptoom van dergelijke patiënten het beste te verlichten zonder de ontwikkeling van de foetus te bestrijden. De meest recente ontwikkelingen in de behandeling van zwangerschapsbraken omvatten een aantal medicijnen zoals vitamine B6, doxylamine en bepaalde anticholinergica.Ook is aangetoond dat sommige psychologische onder...

Video: Auteur in de schijnwerpers: misselijkheid en braken tijdens de zwangerschap verlichten met veilige en effectieve auriculaire acupunctuur 

Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)1,2. Injection studies of twin placentas have shown that such anastomoses are almost invariably present in monochorionic twins and extremely rare in dichorionic twins1. Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses1,2. 
Injection of monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in monochorionic twins and is a required test to reach the diagnosis of TAPS2. In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses3-5. This additional information is of paramount importance for all perinatologists involved in the management and care of monochorionic twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

Twin-to-twin transfusion syndrome and twin anemia polycythemia sequence are two potentially devastating problems in perinatal medicine. Both disorders occur only in monochorionic twins and result from unbalanced blood flow through placental vascular anastomoses. We provide a simple protocol to accurately evaluate the presence of vascular anastomoses using colored dye injection of placental vessels after birth.

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia ...

Mouse In Vivo Placental Targeted CRISPR Manipulation

The placenta is an essential organ that regulates and maintains mammalian development in utero. The placenta is responsible for the transfer of nutrients and waste between the mother and fetus and the production and delivery of growth factors and hormones. Placental genetic manipulations in mice are critical for understanding the placenta's specific role in prenatal development. Placental-specific Cre-expressing transgenic mice have varying effectiveness, and other methods for placental gene manipulation can be useful alternatives. This paper describes a technique to directly alter placental gene expression using CRISPR gene manipulation, which can be used to modify the expression of targeted genes. Using a relatively advanced surgical approach, pregnant dams undergo a laparotomy on embryonic day 12.5 (E12.5), and a CRISPR plasmid is delivered by a glass micropipette into the individual placentas. The plasmid is immediately electroporated after each injection. After dam recovery, the placentas and embryos can continue development until assessment at a later time point. The evaluation of the placenta and offspring after the use of this technique can determine the role of time-specific placental function in development. This type of manipulation will allow for a better understanding of how placental genetics and function impact fetal growth and development in multiple disease contexts.

Mouse In Vivo Placental Targeted CRISPR Manipulation

Here we describe a time-specific method to effectively manipulate critical developmental pathways in the mouse placenta in vivo. This is performed through the injection and electroporation of CRISPR plasmids into the placentas of pregnant dams on embryonic day 12.5.

The placenta is an essential organ that regulates and maintains mammalian development in utero. The placenta is responsible for the transfer of nutrients ...

Genetics

Ex Vivo Perfusion of the Rodent Placenta

The placenta is a key organ during pregnancy that serves as a barrier to fetal xenobiotic exposure and mediates the exchange of nutrients for waste. An assay is described here to perfuse an isolated rat placenta and evaluate the maternal-to-fetal translocation of xenobiotics ex vivo. In addition, the evaluation of physiological processes such as fluid flow to the fetus and placental metabolism may be conducted with this methodology. This technique is suitable for evaluating maternal-to-fetal kinetics of pharmaceutical candidates or environmental contaminants. In contrast to current alternative approaches, this methodology allows the evaluation of the isolated maternal-fetal vasculature, with the systemic neural or immune involvement removed, allowing any observed changes in physiological function to be attributable to local factors within the isolated tissue.

Here is presented a protocol of ex vivo maternal-fetal vascular perfusion to enable the administration of a test article into maternal vasculature and to evaluate placental transfer of xenobiotic particles or pharmacological agents in addition to alterations in placental physiology.

The placenta is a key organ during pregnancy that serves as a barrier to fetal xenobiotic exposure and mediates the exchange of nutrients for waste. An ...

Developmental Biology

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset (Callithrix jacchus)

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset (Callithrix jacchus) is a small, easy-to-handle New World monkey which has a similar anatomy of the temporal bone, including the middle ear ossicular chains and inner ear to humans, than in comparison with that of rodents. Here, we report a reproducible, safe, and rational surgical approach to the cochlear round window niche for the drug delivery to the inner ear of the common marmoset. We adopted posterior tympanotomy, a procedure used clinically in human surgery, to avoid manipulation of the tympanic membrane that may cause conductive hearing loss. This surgical procedure did not lead to any significant hearing loss. This approach was possible due to the large bulla structure of the common marmoset, although the lateral semicircular canal and vertical portion of the facial nerve should be carefully considered. This surgical method allows us to perform the safe and accurate administration of drugs without hearing loss, which is of great importance in obtaining pre-clinical proof of concept for translational research.

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset Callithrix jacchus

We report a surgical method to administrate drugs to the inner ear of a non-human primate, the common marmoset (Callithrix jacchus), via the round window membrane.

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset ...

Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over the world have increased their skills in this field and can provide support to help position the infant at the breast, the impact of their intervention might be limited in the presence of stiff structures in the infants. Here we present a protocol for a randomized controlled trial to assess the efficacy of osteopathic treatment, coupled with lactation consultation, for infants&#39; biomechanical suckling difficulties. It proposes a set-up and a sequence of actions to ensure an optimal context for treatment, as well as a blinding of parents and LCs to the intervention. Data such as the infant&#39;s latch ability measured with the LATCH Assessment Tool, the mother&#39;s nipple pain with a visual analog scale (VAS), and the mother&#39;s perceptions are collected by LCs four times over a 10-day period. Osteopathic lesions are documented by the osteopath, using a standardized assessment grid. Structures of interest are coherent with the anatomical zones involved in latching onto the breast. This protocol also proposes a strategy to document systematically an osteopathic profile of infants with biomechanical suckling difficulties in their first weeks of life. The implementation of this protocol confirms its feasibility for osteopathic assessment and treatment and paves the way for future trials to further explore the efficacy of osteopathic techniques for infants with biomechanical suckling difficulties.

Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over ...

Virtual Prism Adaptation Therapy: Protocol for Validation in Healthy Adults

Hemispatial neglect is a common impairment after stroke. It is associated with poor functional and social outcomes. Therefore, an adequate intervention is imperative for the successful management of hemispatial neglect. However, the clinical use of various interventions is limited in real clinical practice. Prism adaptation therapy is one of the most evidence-based rehabilitation modalities to treat hemispatial neglect. To overcome any possible shortcoming that may occur with prism therapy, we developed a new system using immersive virtual reality and depth-sensing camera to create a virtual prism adaptation therapy (VPAT). To validate the VPAT system, we designed an experimental protocol investigating the behavioral errors and changes in cortical activation via the VPAT system. Cortical activation was measured by functional near infrared spectroscopy (fNIRS). The experiment consisted of four phases. All four included clicking, pointing or rest applied to right-handed healthy people. Clicking versus pointing was used for investigating the cortical region related with the gross motor task, and pointing with VPAT versus pointing without VPAT was used for investigating the cortical region associated with visuospatial perception. The preliminary results from four healthy participants showed that pointing errors by the VPAT system was similar to the conventional prism adaptation therapy. Further analysis with more participants and fNIRS data, as well as a study in patients with stroke may be required.

This experimental protocol demonstrates the use of virtual prism adaptation therapy (VPAT) in healthy adults and the association between VPAT and functional near infrared spectroscopy to determine the effect of VPAT on cortical activation. Results suggest that VPAT may be feasible and could induce similar behavioral adaptation as conventional prism adaptation therapy.

Hemispatial neglect is a common impairment after stroke. It is associated with poor functional and social outcomes. Therefore, an adequate intervention is ...

Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, we propose that a concomitant laparoscopic oocyte retrieval for cryopreservation is performed. Oocyte retrieval is pursued at the beginning of the laparoscopy. Right and left 5 mm trocars are positioned, through which a 17 G ovum aspiration needle is used for puncture of the right and left ovaries, respectively. To facilitate exposure of the follicles, the ovaries are mobilized and held with laparoscopic forceps.
When aspirating multiple follicles near each other, the needle tip is retained in the ovary to reduce the number of times that the ovarian cortex is transfixed and due to the inherent risk of bleeding. Subsequent steps are unchanged compared to the Davydov laparoscopic modified technique for vaginoplasty. Prior to surgery, controlled ovarian stimulation is performed with a gonadotropin hormone-releasing hormone (Gn-RH) antagonist protocol, and the concomitant procedure of oocyte retrieval and vaginoplasty is scheduled 36 h after the final follicular maturation trigger. Follicular fluid is collected in the same 10 mL sterile tubes used during transvaginal oocyte retrieval and transferred in a warming block (37 &#176;C) to the assisted reproduction laboratory, where mature (metaphase II) oocytes are vitrified.
In this case, a series of 23 women with MRKH, oocytes were successfully retrieved and cryopreserved in all patients; vaginoplasty was subsequently conducted without modifications, and the inpatient and outpatient postoperative care (day of urinary catheter removal, day of hospital discharge, dilator use, and comfort at follow-up) remained unaffected. One postoperative complication occurred in one patient (fever developing on day 5 post surgery and intraperitoneal fluid detection on transabdominal ultrasound) and resolved after conservative treatment. Rather than performing surgical vaginoplasty and delaying oocyte retrieval in MRKH patients, this approach combines both procedures in a single laparoscopy, thereby minimizing surgical invasiveness and anesthesiologic risks.

A dedicated team can offer Mayer-Rokitansky-Kuster-Hauser patients the option to perform controlled ovarian stimulation and oocyte cryopreservation at the time of laparoscopic vaginoplasty.

In Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS) patients who are scheduled for laparoscopic vaginoplasty and have a desire for biological motherhood, ...

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury (AGI): A Preliminary Study

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. Traditional Chinese medicine&#39;s acupuncture techniques offer an alternative&#160;approach to treating digestive disorders&#160;by controlling gastrointestinal secretion, improving gastrointestinal motility, and minimizing side effects. Transabdominal intestinal ultrasonography has proven effective in assessing gastrointestinal injury in critically ill patients. This study aims to evaluate the therapeutic effect of acupuncture in AGI patients using ultrasound. The main steps of the study include the syndrome-based selection of appropriate acupuncture points, including&#160;Hegu (LI4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), and Xiajuxu (ST 39), followed by a 30 min Deqi acupuncture session once a day for 1 week. The treatment&#39;s effectiveness is assessed by an experienced physician using abdominal gastrointestinal ultrasonography. This article provides a detailed account of how to standardize the use of acupuncture in treating gastrointestinal dysfunction in critically ill patients.

Acupuncture as a Therapeutic Intervention for Acute Gastrointestinal Injury AGI: A Preliminary Study

Acute gastrointestinal injury (AGI) is a prevalent occurrence in intensive care units and has been linked to unfavorable patient outcomes. The current approaches focus on addressing the primary disease and providing symptomatic relief. The protocol here demonstrates the implementation of acupuncture as a therapeutic intervention for AGI.

Acute gastrointestinal injury (AGI) is a significant factor contributing to increased mortality in patients receiving intensive care unit (ICU) care. ...

Surgical Treatment of Gastroparesis

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives.
The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient&#39;s condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.

Gastroparesis is a condition in which the stomach does not empty properly. While it is initially managed with lifestyle modifications and medications, some patients eventually require surgical intervention. This study focuses on the technical considerations and surgical approaches for dealing with gastroparesis patients, which include endoscopic, minimally-invasive, and open surgical techniques.

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are ...

Enhancing CINV Management: Traditional Chinese Medicine Approaches

Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting

Chemotherapy-induced nausea and vomiting (CINV) refers to the nausea and vomiting experienced by patients after the application of chemotherapy drugs, significantly affecting their quality of life and physical recovery, as well as increasing the pain of the patients. Basic medicine primarily focuses on acid suppression, gastric protection, and vomiting suppression, but there are still many patients with nausea and vomiting symptoms that cannot be alleviated. Traditional Chinese medicine (TCM) can effectively alleviate nausea and vomiting through acupoint stimulation and pressure, while also offering advantages such as simplicity, affordability, and fewer side effects. The aim of this article is to introduce the method of using acupoint application combined with acupressure as an adjunctive therapy for CINV, using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) tablet scale as a questionnaire. The article details aspects such as acupoint selection, production, and the use of acupoint application, massage techniques, and operating procedures, all with the goal of ensuring the safety and efficacy of acupoint application combined with acupressure as an adjuvant therapy, thereby improving patients&#39; clinical symptoms and quality of life.

Acupoint application combined with acupressure-assisted treatment has a good effect on chemotherapy-induced nausea and vomiting and is more convenient and cost-effective.

Chemotherapy-induced nausea and vomiting (CINV) refers to the nausea and vomiting experienced by patients after the application of chemotherapy drugs, ...

Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting

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