Comorbid diseases in pregnancy: Difference between revisions
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==UTI== | ==[[UTI]]== | ||
*Treat all bacteriuria during pregnancy, even if | *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 | ||
**Admit and | **Admit and treat with cephalosporin or [[ampicillin]] + gentamicin | ||
==DKA== | ==[[DKA]]== | ||
*Any pregnant diabetic presenting to ED who is ill appearing and/or | *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 | *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 | **All such patients should receive a screening TSH | ||
*Thyroid storm is treated similarly to non-pregnant | *Thyroid storm is treated similarly to non-pregnant patients | ||
==Hypertensive | ==[[Hypertensive emergency]]== | ||
*Labetalol | *Labetalol is agent of choice | ||
==Thromboembolism== | ==[[Thromboembolism]]== | ||
* | *[[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% | *[[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 | *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, | **Cerebral vein thrombosis, pneumonia, sepsis, pyelonephritis | ||
==Headache== | ==[[Headache]]== | ||
*Manage similar to non-pregnant | *Manage similar to non-pregnant patients except avoid NSAIDs | ||
==Seizure== | ==[[Seizure]]== | ||
*Manage similar to non-pregnant | *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 | |||
== | ==See Also== | ||
*[[Pregnancy (Main)]] | |||
[[Category: | ==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