Comorbid diseases in pregnancy: Difference between revisions
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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 | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:OBGYN]] | [[Category:OBGYN]] |
Revision as of 13:45, 30 March 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
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:
- Cerebral vein thrombosis, pneumonia, sepsis, pyelonephritis
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