Parenteral nutrition in obstetrics and gynecology

Parenteral nutrition is required to maintain and restore an anabolic state when oral or enteral routes are not feasible. Despite 16 years of parenteral nutrition availability, reports about parenteral therapy in gynecologic patients or during pregnancy have not been published until relatively recently. Most information is anecdotal but suggests that this mode of therapy is safe, effective, and occasionally life-saving. Parenteral nutrition is used most commonly in women with gynecologic malignancies who are unable to obtain adequate nourishment either during or after surgery, radiation, or chemotherapy. Parenteral alimentation during pregnancy has been used mostly to provide adequate nutrition for those who suffer from prolonged hyperemesis or when there is difficulty in absorption of adequate nutrients. The proper selection and administration of dextrose, fat, protein, vitamins, trace elements, and electrolytes for pregnant women has been associated with apparent favorable perinatal outcomes. Preterm deliveries and intrauterine fetal growth retardation are relatively common and relate to the preexisting or a coexisting medical or obstetric complication. Nutritional assessment before therapy should include a detailed diet history and establishment of baseline clinical and laboratory parameters. Oral or enteral feedings should be attempted beforehand if possible to conserve high costs and potential complications. Parenteral requirements are extrapolated from recommended daily allowances for oral intake, allowing for adjustments in variable absorption. Standardized formulations and fat emulsions are available at pharmacies in many hospitals, making ordering of complex solutions easier, more efficient, and cost effective. Metabolic and septic complications occur infrequently with close monitoring. Few women require intravenous therapy for very long, and home parenteral nutrition is rarely necessary.