Comorbid diseases in pregnancy

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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 or hydralazine are agents of choice

Thromboembolism

  • PE is the most common cause of maternal death in the developed world
  • The highest daily risk of VTE is during the postpartum period
  • 90% of DVTs occur in the L leg

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)

Source

Tintinalli

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