Comorbid diseases in pregnancy

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 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

Headache

• Manage similar to non-pregnant patients except avoid NSAIDs

Seizure

• 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

• Pregnancy (Main)

References

Authors

Ross Donaldson