View source for 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
**[[Methimazole]] preferred over [[PTU]] in 2nd/3rd trimester, and lowest dose possible should be used

==[[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 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]]==
*Maternal complications are most common during 3rd trimester and postpartum period:
**[[Cerebral venous 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==
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[[Category:OBGYN]]