approach to the pregnant patient |

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

more difficult airway management in third trimester

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

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

I: INTOX

some drugs are not safe to the fetus

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