Hyperemesis gravidarum: outcomes and complications with and without total parenteral nutrition.
OBJECTIVE
To evaluate the obstetric and medical complications with hyperemesis gravidarum, comparing those who were supported with total parenteral nutrition (TPN group) and those who did not receive TPN (non-TPN group).


METHODS
The medical records of women with a diagnosis of hyperemesis gravidarum (ICD-9 code 643) admitted to Crouse Hospital, Syracuse, New York, between January 1995 and December 1998, were reviewed. A total of 166 subjects were identified and 192 admissions reviewed. Information was gathered for age, gestational age, gravity and parity, marital status, length of stay and number of admissions, and a review of electrolyte, albumin and thyroid function was performed. An assessment of pregnancy complications and outcomes was undertaken.


RESULTS
Of the cases reviewed, 16% (27/166) were treated with TPN. The 2 groups were similar regarding incidence of pregnancy-related and maternal medical complications. The groups were similar when comparing objective measures, such as serum potassium, bicarbonate, albumin and thyroid function. The TPN group had a significantly increased incidence of complications directly attributable to parenteral therapy. Among multiparous patients in both groups, 69% had a prior pregnancy that had ended in spontaneous or induced abortion.


CONCLUSIONS
The TPN group had a marked and significant increase in serious complications directly related to TPN use. These data suggest that great care should be taken to assess the need for parenteral therapy in patients with hyperemesis gravidarum. A history of loss in the antecedent pregnancy may be a risk factor for a subsequent pregnancy complicated by hyperemesis gravidarum.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York Upstate Medical University, Syracuse 13210, USA. folkj@upstate.edu
John J
JJ
Folk
Heather F M
HF
Leslie-Brown
John T
JT
Nosovitch
Robert K
RK
Silverman
Richard H
RH
Aubry
D000028:Abortion, Induced / Q000009:adverse effects; D000022:Abortion, Spontaneous / Q000150:complications; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000209:etiology / Q000628:therapy*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects* / Q000295:instrumentation; D011247:Pregnancy; D016459:Prosthesis-Related Infections / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome