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