Medline ® Abstracts for References 115,116
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes.
Holmgren C, Aagaard-Tillery KM, Silver RM, Porter TF, Varner M
Am J Obstet Gynecol. 2008;198(1):56.e1.
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.
Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT, USA. email@example.com
Peripherally inserted central catheter (PICC) complications during pregnancy.
Cape AV, Mogensen KM, Robinson MK, Carusi DA
JPEN J Parenter Enteral Nutr. 2014 Jul;38(5):595-601.
BACKGROUND: Peripherally inserted central catheters (PICCs) are routinely used in women with hyperemesis gravidarum. However, little is known about the consequences of PICC insertion in these patients. Our aim was to analyze PICC-related complication rates among pregnant women.
MATERIALS AND METHODS: Pregnant women with PICC insertion between January 2000 and June 2006 were studied retrospectively. Infusate type, comorbid conditions, and PICC duration were characterized. Major complications, defined as need for surgical intervention, bacteremia requiring intravenous antibiotics, or thromboembolic events, were identified. Minor complications, including phlebitis, PICC malfunction, early PICC removal, infection requiring oral antibiotics, or hospitalization for PICC evaluation, were also studied.
RESULTS: Eighty-four catheters in 66 women were eligible for study, totaling 2544 PICC days. Catheters remained in place for 1-177 days; median duration was 21.0 days. PICCs were used for intravenous fluid (IVF, 59.4%), parenteral nutrition (PN, 34.5%), and antibiotics (6%). The overall complication rate was 18.5 per 1000 PICC days (55.9% of PICCs); 22.6% were major, with bacteremia being most frequent (20.2%). A diagnosis of diabetes was the only factor that significantly predicted complications (hazard ratio, 2.71; 95% confidence interval, 1.13-6.13). PICC duration and type of infusate (PN vs IVF alone) were not associated with complications.
CONCLUSIONS: PICC insertion in pregnant women is associated with a high complication rate, which appears to be independent of the type of infusate and occurs in the majority of women. PICCs should be used judiciously and only when clearly necessary during pregnancy. Further studies are needed to determine how to reduce PICC-related complications in this population.
Mount Kisco Medical Group, Mount Kisco, New York firstname.lastname@example.org.