Successful jejunal nutrition therapy in a pregnant patient with apallic syndrome.

A 41-year-old woman was admitted in the 8th pregnancy week as a consequence of a left-sided media infarction. After alloprothetic aortic valve replacement, she had discontinued deliberately the mandatory anticoagulation treatment. Following an initial clinical stabilisation, a second insult with right-sided media total infarction occurred 3 weeks after admission. In the further course, she developed an apallic syndrome and required respirator therapy. The initial enteral nutrition therapy via naso-gastric tube, was continued via percutaneous endoscopic gastrostomy (PEG). Due to recurrent vomiting from the 24th pregnancy week, the PEG was changed into a PEG with jejunal position of the tube (JET-PEG). Via this access and simultaneous body impedance analysis (BIA) control, the further nutrition therapy could be continued uneventfully. In the 27th pregnancy week, the patient gave birth to a female newborn (birth weight: 820 g) by Caesarean section in pre-eclampsia. The foetal development was in accordance with the gestational period and uncomplicated in the further course. The mother could be released into ambulatory care where the above nutrition therapy was continued. Reports on a successful nutrition therapy of pregnant comatose patients are rare. To the best of our knowledge, this is the first case where JET-PEG and monitoring by repeated BIA measurement were used for the control of the enteral nutrition.

[1]  P. Christian Maternal nutrition, health, and survival. , 2002, Nutrition reviews.

[2]  A. Dormann,et al.  Sondenernährung - Wer, Wie, Wann? , 2002 .

[3]  C. Pearce,et al.  Enteral nutrition by nasojejunal tube in hyperemesis gravidarum. , 2001, Clinical nutrition.

[4]  E. Masson,et al.  Pregnancy outcome in a patient with chronic malnutrition: case report. , 2000, Human reproduction.

[5]  T. McElrath,et al.  Nutrition in adolescent pregnancy , 2000, Current opinion in pediatrics.

[6]  M. Antal [Current questions concerning nutrition during pregnancy]. , 1999, Orvosi hetilap.

[7]  T. Maruo,et al.  Potential use of bioelectrical impedance analysis in the assessment of edema in pregnancy. , 1999, Clinical and experimental obstetrics & gynecology.

[8]  Y. K. Chen,et al.  Percutaneous endoscopic gastrostomy for nutrition support in pregnancy associated with hyperemesis gravidarum and anorexia nervosa. , 1998, JPEN. Journal of parenteral and enteral nutrition.

[9]  P. García-Luna,et al.  Enteral nutrition by percutaneous endoscopic gastrojejunostomy in severe hyperemesis gravidarum: a report of two cases. , 1998, Clinical nutrition.

[10]  A. Ferguson,et al.  Successful pregnancy in a patient with chronic intestinal pseudo-obstruction while on ambulatory percutaneous endoscopic gastrostomy feeding. , 1997, European journal of gastroenterology & hepatology.

[11]  E. Lipkin,et al.  Nutrition support of a pregnant comatose patient via percutaneous endoscopic gastrostomy. , 1993, JPEN. Journal of parenteral and enteral nutrition.

[12]  J. Gulley,et al.  Treatment of hyperemesis gravidarum with nasogastric feeding. , 1993, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[13]  B. Barclay Experience with enteral nutrition in the treatment of hyperemesis gravidarum. , 1990, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[14]  Landye St Successful enteral nutrition support of a pregnant, comatose patient: a case study. , 1988 .

[15]  B. O'neill,et al.  Management of maternal vegetative state during pregnancy. , 1985, Mayo Clinic proceedings.

[16]  Petersen Lp,et al.  Post-traumatic coma during pregnancy. , 1979 .