If the woman does not respond to the recommended management interventions, they should be assessed by a dietitian to consider commencing short-term enteral feeding. Small studies have shown enteral feeding is safe and effective in temporarily aiding fetal and maternal nutrition in severe HG. Undertake a detailed nutritional assessment to determine the feeding regimen required.
Nausea and vomiting have been shown to improve within 24 hours after starting enteral feeding. Insert an 8 french gauge nasogastric tube (NGT). Correct placement of the NGT must be determined prior to commencing enteral feeding. Consider starting a continuous infusion of standard, iso-osmolar (for example, Osmolite, Jevity) formula at a rate of 20 mL/hr/day. Increase the rate by 10 mL/hr/day until the target rate as determined by the dietitian is achieved. Once the target rate is reached, consider delivering the total daily volume over 8–12 hours overnight. Monitor closely for refeeding syndrome complications. Discontinue enteral nutrition when 100 per cent of the woman’s nutritional needs are being met orally.
If enteral nutritional support is unsuccessful, trial parenteral nutrition. Total parenteral nutrition is a complex intervention. It should only be used as a last measure as it as it can be associated with serious complications.