Total Parenteral Nutrition (TPN) and Steroid Usage in the Management of Hyperemesis Gravidarum

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that the usual nausea and vomiting of early pregnancy can become persistent and severe. In a series of 92,838 consecutive antenatal patients at the Mercy Hospital for Women, 1.1% had vomiting of sufficient severity to warrant admission to hospital. Most admissions were of 2–6 days' duration and more than 70% required only 1 admission. However, the condition was refractory in about 10% of these women who required repeated admissions to hospital. As in the case reported here the condition can be recurrent in subsequent pregnancies. In the series quoted above, 75% of the women were admitted in the first 14 weeks of pregnancy, and the positive association with multiple pregnancy (21 cases), hydatidiform mole (7 cases) and urinary tract infection (31 cases) was less than expected. Nonetheless these conditions should always be excluded. When the editor was a medical officer at The Royal Women's Hospital, Melbourne, 1957–1960, he saw 2 cases of hyperemesis gravidarum where the vomiting of black fluid was suggestive of acute dilatation of the stomach. Both women were moribund. The first woman had a hydatidiform mole and hysterotomy was performed successfully. The second woman, who had required prolonged hospitalization in her only other pregnancy, was treated successfully by hypnosis by our Indian resident medical officer. The vomiting ceased, but the hypnosis was reinforced daily and the woman remained in hospital for several weeks. In the series quoted, there was a history of past psychiatric disease in 6.3% and many of the remaining women had an underlying problem of anxiety, depression or psychosocial disturbance. Since these women have dehydration and even starvation when admitted to hospital they should receive vitamins as well as intravenous fluids, calories and antinausea preparations as in the case presented here.