Research
Obstetrics
Hyperemesis in pregnancy: An evaluation of treatment strategies with maternal and neonatal outcomes

https://doi.org/10.1016/j.ajog.2007.06.004Get rights and content

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.

Study Design

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).

Conclusion

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.

Section snippets

Materials and Methods

This study was approved by the Institutional Review Board at the University of Utah and LDS Hospitals. International Classification of Diseases, Ninth Revision (ICD-9) codes for nausea and vomiting in pregnancy and hyperemesis (643.01-.09) were used to identify a cohort of patients admitted for treatment from 1998 to 2004. Inclusion criteria included a singleton viable intrauterine pregnancy documented by first-trimester ultrasound; at least 1 24 hour admission to the hospital for treatment of

Results

Between 1998 and 2004, 129 patients were identified at 2 large urban tertiary medical centers. Of these, 35 patients, meeting initial requirements for inclusion, were excluded from the analysis for maternal gastrointestinal illness, unknown maternal or fetal outcome secondary to delivery at outside facility or management with a nasogastric/nasoduodenal tube, and a PICC line. Of the 94 remaining patients, 33 had a PICC line placed (35.1%), 19 had a nasogastric/nasoduodenal tube placed (20.2%),

Comment

There were striking differences between the groups concerning maternal complications. Our study reveals serious complications of bacteremia, sepsis, and thrombosis observed in a majority of the patients in the PICC line group. In several cases, these complications were severe enough to require admission to an intensive care unit and rigorous therapeutic interventions. All of the patients experiencing either infection or thrombosis required antibiotic or anticoagulant therapy. In addition, since

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Cite this article as: Holmgren C, Aagaard-Tillery KM, Silver RM, et al. Hyperemesis in pregnancy: An evaluation of treatment strategies with maternal and neonatal outcomes. Am J Obstet Gynecol 2008;198:56.e1-56.e4.

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