Comorbid diseases in pregnancy: Difference between revisions

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==UTI==
==[[UTI]]==
*Treat all bacteriuria during pregnancy, even if pt is asymptomatic (reduces 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
*Pyelo
*Pyelonephritis
**Admit and tx with cephalosporin or amp + gent
**Admit and treat with cephalosporin or [[ampicillin]] + gentamicin


==DKA==
==[[DKA]]==
*Any pregnant diabetic presenting to ED who is ill appearing and/or w/ BS > 180 should be screened for 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 w/ DKA are the same as for nonpregnant pts
*Management guidelines for pregnant women with DKA are the same as for nonpregnant patients


==Hyperthyroidism==
==[[Hyperthyroidism]]==
*Thyrotoxicosis in pregnancy may present as hyperemesis gravidarum
*Thyrotoxicosis in pregnancy may present as hyperemesis gravidarum
**All such pts should receive a screening TSH
**All such patients should receive a screening TSH
*Thyroid storm is treated similarly to non-pregnant pts
*Thyroid storm is treated similarly to non-pregnant patients


==Hypertensive Emergency==
==[[Hypertensive emergency]]==
*Labetalol or hydralazine are agents of choice
*Labetalol is agent of choice


==Thromboembolism==
==[[Thromboembolism]]==
*PE is the most common cause of maternal death in the developed world
*[[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
*90% of DVTs occur in the L leg
*[[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==
==[[Asthma]] Exacerbation==
*Treatment is similar to non-pregnant pts 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 vein thrombosis, PNA, sepsis, pyelo
**Cerebral vein thrombosis, pneumonia, sepsis, pyelonephritis


==Headache==
==[[Headache]]==
*Manage similar to non-pregnant pts except avoid NSAIDs
*Manage similar to non-pregnant patients except avoid NSAIDs


==Seizure==
==[[Seizure]]==
*Manage similar to non-pregnant pt
*Manage similar to non-pregnant patient
*Aggressively treat status epilepticus (intubation)
*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


==Source==
==See Also==
Tintinalli
*[[Pregnancy (Main)]]


[[Category:OB/GYN]]
==References==
<references/>
 
[[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

See Also

References