Comorbid diseases in pregnancy

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

• Pregnancy (Main)

References

Tintinalli