Comorbid diseases in pregnancy: Difference between revisions
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==[[UTI]]== | ==[[UTI]]== | ||
*Treat all bacteriuria during pregnancy, even if patient is asymptomatic (reduces risk of pyelo) | *Treat all bacteriuria during pregnancy, even if patient is asymptomatic (reduces risk of pyelo) | ||
*Cystitis | *[[Cystitis]] | ||
**Nitrofurantoin 100mg PO BID x3-10d is agent of choice | **[[Nitrofurantoin]] 100mg PO BID x3-10d is agent of choice | ||
*Pyelonephritis | *[[Pyelonephritis]] | ||
**Admit and treat with cephalosporin or ampicillin + gentamicin | **Admit and treat with [[cephalosporin]] or [[ampicillin]] + [[gentamicin]] | ||
==[[DKA]]== | ==[[DKA]]== | ||
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==[[Hyperthyroidism]]== | ==[[Hyperthyroidism]]== | ||
*Thyrotoxicosis in pregnancy may present as hyperemesis gravidarum | *[[Thyrotoxicosis]] in pregnancy may present as [[hyperemesis gravidarum]] | ||
**All such patients should receive a screening TSH | **All such patients should receive a screening TSH | ||
*Thyroid storm is treated similarly to non-pregnant patients | *[[Thyroid storm]] is treated similarly to non-pregnant patients | ||
**[[Methimazole]] preferred over [[PTU]] in 2nd/3rd trimester, and lowest dose possible should be used | |||
==[[Hypertensive emergency]]== | ==[[Hypertensive emergency]]== | ||
*Labetalol is agent of choice | *[[Labetalol]] is agent of choice | ||
==[[Thromboembolism]]== | ==[[Thromboembolism]]== | ||
*[[Warfarin]] is contraindicated during pregnancy | *[[Warfarin]] is ''contraindicated'' during pregnancy | ||
*The highest daily risk of VTE is during the postpartum period | *The highest daily risk of VTE is during the postpartum period | ||
*[[DVT]] | *[[DVT]] | ||
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**Most common cause of maternal death in the developed world | **Most common cause of maternal death in the developed world | ||
**If suspect and lower extremity ultrasound shows DVT, treat empirically for PE | **If suspect and lower extremity ultrasound shows DVT, treat empirically for PE | ||
**If suspect and | **If suspect and lower extremity [[ultrasound]] is negative obtain CT chest | ||
***Risk to fetus of childhood cancer from single scan is <1 case per million | ***Risk to fetus of childhood cancer from single scan is <1 case per million | ||
==[[Asthma]] Exacerbation== | ==[[Asthma]] Exacerbation== | ||
*Treatment is similar to non-pregnant patients except only use epinephrine if critically ill | *Treatment is similar to non-pregnant patients except only use [[epinephrine]] if critically ill | ||
**Concern about potential vasoconstriction of uteroplacental circulation | **Concern about potential vasoconstriction of uteroplacental circulation | ||
==[[Sickle Cell Disease]]== | ==[[Sickle Cell Disease]]== | ||
*Maternal complications are most common during 3rd trimester and postpartum period: | *Maternal complications are most common during 3rd trimester and postpartum period: | ||
**Cerebral | **[[Cerebral venous thrombosis]], [[pneumonia]], [[sepsis]], [[pyelonephritis]] | ||
==[[Headache]]== | ==[[Headache]]== | ||
*Manage similar to non-pregnant patients except avoid NSAIDs | *Manage similar to non-pregnant patients except avoid [[NSAIDs]] | ||
==[[Seizure]]== | ==[[Seizure]]== | ||
*Manage similar to non-pregnant patient | *Manage similar to non-pregnant patient | ||
*Aggressively treat [[status epilepticus]] (intubation) | *Aggressively treat [[status epilepticus]] (intubation) | ||
*[[Magnesium]] if at risk for [[eclampsia]] (>20wks gestation or <4wks postpartum | *Treat with [[Magnesium]] if at risk for [[eclampsia]] (>20wks gestation or <4wks postpartum | ||
**Load 4-6g IV over 15min followed by 2-3gm/hr | **Load 4-6g IV over 15min followed by 2-3gm/hr | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:OBGYN]] | [[Category:OBGYN]] | ||
Latest revision as of 19:01, 3 October 2019
UTI
- Treat all bacteriuria during pregnancy, even if patient is asymptomatic (reduces risk of pyelo)
- Cystitis
- Nitrofurantoin 100mg PO BID x3-10d is agent of choice
- Pyelonephritis
- Admit and treat with cephalosporin or ampicillin + gentamicin
DKA
- Any pregnant diabetic presenting to ED who is ill appearing and/or has blood glucose > 180 should be screened for DKA
- Management guidelines for pregnant women with DKA are the same as for nonpregnant patients
Hyperthyroidism
- Thyrotoxicosis in pregnancy may present as hyperemesis gravidarum
- All such patients should receive a screening TSH
- Thyroid storm is treated similarly to non-pregnant patients
- Methimazole preferred over PTU in 2nd/3rd trimester, and lowest dose possible should be used
Hypertensive emergency
- Labetalol is agent of choice
Thromboembolism
- Warfarin is contraindicated during pregnancy
- The highest daily risk of VTE is during the postpartum period
- DVT
- 90% occur in the left leg
- Pulmonary embolism in pregnancy
- Most common cause of maternal death in the developed world
- If suspect and lower extremity ultrasound shows DVT, treat empirically for PE
- If suspect and lower extremity ultrasound is negative obtain CT chest
- Risk to fetus of childhood cancer from single scan is <1 case per million
Asthma Exacerbation
- Treatment is similar to non-pregnant patients except only use epinephrine if critically ill
- Concern about potential vasoconstriction of uteroplacental circulation
Sickle Cell Disease
- Maternal complications are most common during 3rd trimester and postpartum period:
Headache
- Manage similar to non-pregnant patients except avoid NSAIDs
Seizure
- Manage similar to non-pregnant patient
- Aggressively treat status epilepticus (intubation)
- Treat with Magnesium if at risk for eclampsia (>20wks gestation or <4wks postpartum
- Load 4-6g IV over 15min followed by 2-3gm/hr