Comorbid diseases in pregnancy
UTI
- Treat all bacteriuria during pregnancy, even if pt is asymptomatic (reduces pyelo)
- Cystitis
- Nitrofurantoin 100mg PO BID x3-10d is agent of choice
- Pyelo
- Admit and tx with cephalosporin or amp + gent
DKA
- Any pregnant diabetic presenting to ED who is ill appearing and/or w/ BS > 180 should be screened for DKA
- Management guidelines for pregnant women w/ DKA are the same as for nonpregnant pts
Hyperthyroidism
- Thyrotoxicosis in pregnancy may present as hyperemesis gravidarum
- All such pts should receive a screening TSH
- Thyroid storm is treated similarly to non-pregnant pts
Hypertensive Emergency
- Labetalol is agent of choice
Thromboembolism
- Coumadin is contraindicated during pregnancy
- The highest daily risk of VTE is during the postpartum period
- DVT
- 90% occur in the L leg
- PE
- Most common cause of maternal death in the developed world
- If suspect and LE US shows DVT treat empirically for PE
- If suspect and LE US 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 pts 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:
- Cerebral vein thrombosis, PNA, sepsis, pyelo
Headache
- Manage similar to non-pregnant pts except avoid NSAIDs
Seizure
- Manage similar to non-pregnant pt
- Aggressively treat status epilepticus (intubation)
Source
Tintinalli