Total parenteral nutrition in gynecology and obstetrics

Although total parenteral nutrition (TPN) is accepted for the general surgical patient, it also has applications in management of certain gynecologic and obstetric patients. Over an 8.5-year period, 30 patients at a community hospital were referred for TPN from the obstetric and gynecologic service. The gynecologic patients were subdivided into 3 groups: those with rectovaginal fistulas, in whom colostomies were avoided; those with postoperative enterocutaneous fistulas and starvation; and those with postoperative prolonged ileus or mechanical intestinal obstruction and malnutrition, occasionally complicated by previous irradiation. Treatment with TPN obviated the need for surgery in many patients and improved the perioperative condition in others. In obstetrics, TPN was valuable in the treatment of severe hyperemesis gravidarum, inflammatory bowel disease, and the critically ill neonate. TPN can be an effective therapeutic tool in the management of a wide range of major nutritional problems facing the obstetrician-gynecologist.