Comorbid diseases in pregnancy



  • 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


Hypertensive emergency


  • 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 lower extremity 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


  • 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