Comorbid diseases in pregnancy

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  • 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


  • 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


  • 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


  • 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 LE 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


  • Manage similar to non-pregnant patients except avoid NSAIDs


  • 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