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 pt is asymptomatic (reduces pyelo)
*Cystitis
*Cystitis
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**Admit and tx with cephalosporin or amp + gent
**Admit and tx with cephalosporin or amp + gent


==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 w/ BS > 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 w/ DKA are the same as for nonpregnant pts


==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 pts should receive a screening TSH
*Thyroid storm is treated similarly to non-pregnant pts
*Thyroid storm is treated similarly to non-pregnant pts


==Hypertensive Emergency==
==[[Hypertensive emergency]]==
*Labetalol is agent of choice
*Labetalol is agent of choice


==Thromboembolism==
==[[Thromboembolism]]==
*Coumadin is contraindicated during pregnancy
*Coumadin 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]]
**90% occur in the L leg
**90% occur in the L leg
*PE
*[[PE]]
**Most common cause of maternal death in the developed world
**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 shows DVT treat empirically for PE
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***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 pts except only use epinephrine if critically ill
*Treatment is similar to non-pregnant pts 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, PNA, sepsis, pyelo


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


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


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


[[Category:OB/GYN]]
[[Category:OB/GYN]]

Revision as of 11:30, 12 May 2015

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)

See Also

References

Tintinalli