Comorbid diseases in pregnancy: Difference between revisions
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==[[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 | ||
*[[DVT]] | *[[DVT]] | ||
**90% occur in the | **90% occur in the left leg | ||
*[[ | *[[Pulmonary embolism in pregnancy]] | ||
**Most common cause of maternal death in the developed world | **Most common cause of maternal death in the developed world | ||
**If suspect and | **If suspect and lower extremity ultrasound shows DVT, treat empirically for PE | ||
**If suspect and LE US is negative obtain CT chest | **If suspect and LE US is negative obtain CT chest | ||
***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 | ||
Revision as of 20:29, 12 July 2016
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 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 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, PNA, sepsis, pyelo
Headache
- Manage similar to non-pregnant patients except avoid NSAIDs
Seizure
- Manage similar to non-pregnant pt
- Aggressively treat status epilepticus (intubation)