Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes.
OBJECTIVE
The objective of the study was to evaluate the use of interventions such as a peripherally inserted central catheters (PICC) line or nasogastric (NG)/nasoduodenal (ND) tube with the use of medications alone in the management of pregnancies with hyperemesis.


METHODS
Subjects were identified with confirmed intrauterine pregnancy, admitted with hyperemesis gravidarum (HEG) between 1998 and 2004. Medical records were then abstracted for information with regard to therapy. Subjects were assigned on the basis of the management plan: medication alone, PICC line, or NG/ND tube. Outcomes were compared between groups.


RESULTS
Ninety-four patients met study criteria and had complete outcome data available. Of those, 33 had a PICC line placed (35.1%), 19 had a NG/ND placed (20.2%), and 42 were managed with medication alone (44.7%). These groups were similar with respect to gestational age at delivery, Apgar score, and mean birthweight. Maternal complications were significantly higher among those with PICC lines. Of patients managed with PICC lines, 66.4% (P < .001) required treatment for infection, thromboembolism, or both. Adjusted odds ratio for a PICC line complication was 34.5 (5.09, 233.73).


CONCLUSIONS
Maternal complications associated with PICC line placement are substantial despite no difference in neonatal outcomes, suggesting that the use of PICC lines for treatment of HEG patients should not be routinely used.
Holmgren
Calla
C
Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA. cholmgren73@yahoo.com
Aagaard-Tillery
Kjersti M
KM
Silver
Robert M
RM
Porter
T Flint
TF
Varner
Michael
M
D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D002405:Catheterization, Central Venous; D015331:Cohort Studies; D004750:Enteral Nutrition; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000175:diagnosis* / Q000628:therapy*; D007262:Infusions, Intravenous; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000932:Antiemetics