This Article Full Text Full Text (PDF) All Versions of this Article: 0148607109333000v1 33/5/529    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Saha, S. Articles by Degli-Esposti, S. PubMed PubMed Citation Articles by Saha, S. Articles by Degli-Esposti, S. Social Bookmarking                         What's this?

Feeding Jejunostomy for the Treatment of Severe Hyperemesis Gravidarum: A Case Series

From the ¹ Center for Women's Digestive Disorders, Women & Infants Hospital, Providence, Rhode Island;² Department of Surgery, Rhode Island Hospital, Providence, Rhode Island; and ³ Department of Medicine, Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health; Madison, Wisconsin.

Address correspondence to: Sumona Saha, MD, Department of Medicine, Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, H6/516 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-5124; e-mail: ssaha{at}medicine.wisc.edu.

Background: Hyperemesis gravidarum is severe nausea and vomiting during pregnancy leading to dehydration, nutrition deficiency, and fetal morbidity and mortality. Treatment must maintain fluid and electrolyte balance and caloric intake. Parenteral nutrition is often attempted; however, complication rates are high. Nutrition via nasoenteric and percutaneous endoscopic gastrostomy tubes is limited by poor patient tolerance, tube dislodgement, and altered anatomy in pregnancy. Methods: Women with hyperemesis gravidarum who failed standard therapy were offered jejunostomy. All patients underwent surgical jejunostomy in the second trimester. Isotonic tube feeds were administered to a goal caloric factor calculated by the Harris-Benedict equation with a correction added for pregnancy. Patients were monitored until delivery. Results: Five women underwent jejunostomy placement at our institution between 1998 and 2005. One patient underwent jejunostomy placement twice for consecutive pregnancies. The mean body weight loss from prepregnancy was 7.9% (range, 4.0%–15.9%). Patients underwent jejunostomy placement between 12 and 26 weeks of gestation (median 14 weeks). Twelve to 16 Fr catheters were placed in the proximal jejunum. Maternal weight gain occured in 5 of 6 pregnancies. The mean duration of tube placement was 19 weeks (range, 8–28 weeks). All pregnancies ended with term deliveries (range, 36–40 weeks of gestation). The mean infant birth weight was 2885 g (range, 2270–4000 g). Tube-related complications were limited to dislodgement in 2 patients in the third trimester. No cases of infection, bleeding, or preterm labor occured. Conclusions: Feeding via jejunostomy is a potentially safe, effective, and well-tolerated mode of nutrition support therapy in hyperemesis gravidarum.

Key Words: hyperemesis gravidarum • enteral nutrition • jejunostomy

This version was published on September 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 5, 529-534 (2009)
DOI: 10.1177/0148607109333000


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?