Fetal salvage with maternal total parenteral nutrition: the pregnant mother as her own control.

Hyperemesis gravidarum affects both maternal and fetal well-being by reducing maternal vascular volume (normally increased with pregnancy) and depleting maternal nutritional stores. Severe intractable hyperemesis may result in fetal demise. This report documents the ability to maintain maternal fluid and nutritional requirements during first trimester pregnancy in a female with intractable hyperemesis gravidarum. Additionally, this patient is unique in that her five prior pregnancies were complicated by hyperemesis with the last three resulting in fetal demise. Speculation regarding the relative importance of inadequate hydration and nutrition in first trimester fetal viability is given. When hyperemesis is unresponsive to conventional management, intravenous hydration should be instituted without delay to preserve maternal intravascular blood volume and thus placental blood flow. Consideration for total parenteral nutrition can then be given which, after adequate in-hospital instruction, may in most cases be continued in the home.