approach to the pregnant patient

Female doctor auscultating the chest of a pregnant patient on an examination table in a hospital

Pregnant patients undergo many physiological changes that can result in fatigue, edema and shortness of breath. But these can also be signs of emergencies, which we can consider using a systems-based approach

A

  • more difficult airway management in third trimester

B

C: CARDIOVASCULAR

  • RV strain: risk of PE from hypercoagulable
  • Dysfunctional LV: risk of peripartum cardiomyopathy
  • Outflow: risk of dissection from wall stress
  • Volume depletion from hyperemesis
  • Child-bearing: ectopic
  • Lactate sepsis: treat asymptomatic bacteriuria

D: NEUROLOGIC

  • Neuron seizure from pre-eclampsia
  • RBC clot: risk dural vein sinus thrombosis from hypercoagulable

E

  • hOrmone: risk of hypothyroidism

F: PELVIC

  • Pregnant/miscarriage
  • Ectopic risk, including heterotopic in fertility treatment
  • Vacular torsion

G: ABDOMINAL

  • Biliary disease higher risk; consider pre-eclampsia in RUQ pain
  • Dyspepsia: Mallory-Weiss vomiting
  • Appy exam difficult

H

I: INTOX

  • some drugs are not safe to the fetus

J

  • swollen extremities: r/o pre-eclampsia; consider DVT (unilateral) or CMO (sob)

 

Putting this together

  • A: difficult airway in third trimester: ramp and pelvic tilt
  • B
  • C: consider PE, CMO, dissection if chest pain/sob; r/o ectopic, treat infections including asymptomatic UTI, rehydrate
  • D: consider DSVT and pre-eclampsia if headache
  • E: consider hypothyroid if fatigue
  • F: r/o ectopic and torsion if pain
  • G: consider chole/appy if abdo pain, low threshold for US
  • H
  • I: consider drug safety
  • J: consider PET/DVT/CMO if swollen extremities

pregnant

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