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 | ==[[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) | ||
== | ==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