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If HG continued past mid-pregnancy, did you experience complications during delivery related to your poor health such as a strained ligaments/joints, pelvic floor damage, prolonged or weak pushing, fainting, low blood pressure, low pain tolerance, forceps/assisted delivery, broken bones, nerve damage, low amniotic fluid, fetal problems due to difficult delivery, etc.?

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Offsite Resources
  • Multi-Vitamin Infusion
    Critical parenteral vitamins with vitamin K.
  • Ginger People
    Award-winning ginger products that may help ease a queasy stomach.
  • Juice Plus
    An all-natural, whole foods supplement in a gummie bear, protein shake or capsule form.
  • NutriHarmony
    Ultra-fine protein powder that is rich in whole nutrients v. concentrated vitamin extracts (the vitamin smell often increases nausea).
  • Nutritional Programs for Pregnancy
    Read more on the nutritional requirements during pregnancy by Elson M. Haas M.D.
  • Dietary Suggestions
    Dietary guidelines for women with HG. (PDF)

Parenteral (Intravenous) Nutritional Therapy

After several weeks of vomiting, you can become very malnourished, yet this may not be realized by health professionals who only see you periodically. This is especially true if you are above your ideal body weight prior to pregnancy. TPPN (Total Peripheral Parenteral Nutrition) or TPN (Total Parenteral Nutrition) may be ordered by your physician to ensure you receive adequate nutrition. TPPN supplies many more nutrients than basic IV fluids, and may be given in a regular (peripheral) IV in the arm. However, the IV will typically only last for a few days and will then need to be replaced.

TPN supplies most of you daily nutritional requirements and is usually given through a catheter called a PICC line placed in the arm, or a central venous line placed in the neck/shoulder area. Local anesthetic is given to minimize pain during the procedure. These catheters are much longer and the end point is in the heart. This allows very concentrated nutrients to be given without damage to the smaller blood vessels of the arms. It is important to note that TPPN/TPN is not a complete formula. Added multivitamins are very important to avoid nutritionally-related complications.

Management of HG with Parenteral Nutrition

Once you lose over 5% of your pre-pregnancy body weight, nutritional therapies should be discussed, especially if you continue to have significant nausea, vomiting, and weight loss. At a minimum, IV home therapy with added vitamins should be administered after a few weeks of frequent vomiting. Once you lose 8-10% of your body weight or have been vomiting for more than a month, it is imperative that you receive support to replace the many nutrients you have lost and to maintain your hydration. TPPN or TPN is the next choice for ongoing replacement. Dehydration perpetuates the vomiting cycle, as do nutritional deficiencies. If nutritional support is not offered and/or you are not responding to anti-vomiting medications, a second opinion with a specialist may be needed.

See our Referral Network for tips on finding a doctor experienced in treating HG. You may need a friend or spouse to advocate for you while you are sick.

Medications v. Parenteral Nutrition

While nutritional support is important, some physicians initiate home TPN without having first attempted an adequate trial of antiemetic medications. Serious complications are possible when central venous lines are placed, as well as metabolic and infectious complications. These are usually due to insertion technique, improper care of the IV site or line, or inadequate monitoring of your metabolic and nutritional status with blood tests. However, these problems are estimated to occur in only a small percentage of women with HG, even when TPN is given at home.

Before TPN is begun, consideration should be given to aggressive anti-vomiting medications and home IV therapy with vitamins, which do not put you at risk for any life-threatening complications. A growing number of women report that drugs from the serotonin antagonist category (e.g. Zofran, Anzemet, Kytril) have been used in higher doses in their subsequent pregnancies, eliminating the need for TPN and even IV's in some cases. Many physicians (and midwives) are not familiar with the use of these drugs during pregnancy, and are reluctant to offer them in adequate doses (and early enough) to give mothers relief from incessant vomiting. Feel free to refer your health professionals to our site for assistance or find a physician up-to-date on caring for mothers with hyperemesis.

Most Common Complications of Parenteral Nutrition
Metabolic complications:
Hyperglycemia Increased glucose levels. Very common complication of parenteral nutrition. Close monitoring is important during pregnancy, esp. if using glucocorticoid (steroid) therapy.
Hypoglycemia Decreased glucose levels. Most commonly related to abrupt discontinuation of TPN.
Essential fatty acid deficiency May result from parenteral nutrition regimen without intravenous fat (lipid) administration. Replacement is important during pregnancy.
Electrolyte imbalance Inadequate or excess administration of electrolytes (sodium, potassium, etc.) in parenteral nutrition solutions. Losses also occur due to vomiting.
Fluid volume disturbances Volume deficit or volume overload (particularly important in pregnancy to maintain uterine flow).
Mechanical complications:
Catheter related Clots, infection, etc.
Site related Pain, inflammation, or redness.
  Adapted from www.nyschp.org, www.medscape.com and other sources.

 

Updated on: Apr. 18, 2013

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