Hyperemesis in Pregnancy: An Evaluation of Treatment Strategies With Maternal and Neonatal Outcomes

Abstract

Hyperemesis gravidarum (HEG) is characterized by severe nausea and vomiting during pregnancy. It may be associated with weight loss, dehydration, and electrolyte imbalance as well as long-term damage to the liver, kidneys, or central nervous system. HEG can last throughout pregnancy and may cause preterm birth or a prolonged time in hospital. Long-term intravenous access may be necessary, but use of a peripherally inserted central catheter (PICC) line remains controversial because of the risk of serious complications. This study enrolled 94 women with confirmed intrauterine pregnancies who were admitted with HEG in the years 1998–2004. Thirty-three of them had a PICC line placed; 19 received a nasogastric (NG) or nasoduodenal (ND) tube; and 42 were treated solely by IV medications. Five of the patients managed with a PICC line received total parenteral nutrition. The 3 treatment groups were similar with regard to gestational age at delivery, Apgar score, and mean birth weight. Maternal complications were significantly higher in patients with a PICC line, two-thirds of whom required treatment for infection, thromboembolism, or both these conditions. The adjusted odds ratio for a PICC line complication was 34.5 (P < 0.001). There were 3 fetal losses in the PICC line group, 1 spontaneous abortion in the medication-only group, and no losses or miscarriages in the NG/ND tube group. Three patients in the PICC line group and one in the NG/ND tube group terminated their pregnancies because of HEG. Three women had drug complications, all of which resolved when the medication was withdrawn. The investigators conclude that use of a PICC line for treating HEG rarely is indicated and—except in particular circumstances—should be avoided. Use of a NG or ND tube might be the best option when HEG proves unresponsive to strictly medical management.