The fetal head evaluation during labour in the occiput posterior position: the esa (evaluation by simulation algorithm) approach

Objective: To assess pregnancy outcome among women with hyperemesis gravidarum (HEG) with and without total parenteral nutrition (TPN) support. Study Design: A retrospective study of all pregnant women with singleton pregnancies who were hospitalized due to HEG between 1997 and 2011. Pregnancy outcome was compared with a control group without HEG matched by maternal age and parity in a 3:1 ratio. Results: Overall 599 women were admitted during the study period with the diagnosis of HEG and subsequently delivered in our center. Of those, 122 (20.4%) received TPN support. Women in the HEG group were characterized by a higher rate of severe preeclampsia (1.3% vs. 0.5%, p=0.04), and a higher rate of preterm delivery at less than 37 and 34 weeks (10.9% vs. 6.9%, p<0.001, and 4.7% vs. 1.6%, p<0.001, respectively). Neonates in the HEG group were characterized by a lower birthweight (3074±456g vs. 3248±543g, p<0.001), higher rate of birthweight<10th percentile (12.7% vs. 6.8%, P<0.001), and a higher rate of neonatal morbidity (8.7% vs. 3.8%, p<0.001). These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who did not receive TPN support. Conclusion: HEG is an independent risk factor for adverse pregnancy outcome. TPN support during early pregnancy is associated with a decreased risk for perinatal morbidity.