ObstetricEmergencies.pptVIP

* * * * * * * * * * * * * Pre-eclampsia: To be considered in those 20wks with HTN Mild SBP 140 (or +20 from baseline. Or DBP 90 (or +10 from baseline) Proteinuria .3g/24h +/- Edema No Oliguria No Associated symptoms Normal labs No IUGR Severe BP160/90 Proteinuria 5g/24h Edema Present Oliguric Associated symptoms (H/A, visual symptoms, abdominal pain, pulm. edema Associated labs (dec. plts, inc. LFT, inc. bili, inc. creatinine, increased uric acid) IUGR present HELLP syndrome = very severe. Above +RUQ pain, n/v Management Isolated HTN requires a 24h urine and close Ob f/u With other findings, admit, 24h urine, bed rest and HTN management in consult with ob/gyn. Hydralazine common though diazoxide, labetalol, nifedipine and nitroprusside also used +/- Mag to prevent seizures Complications of Pregnancy: Eclampsia Preeclampsia +seizures or coma May occur without proteinuria, may occur up to 10 days postpartum ICH is the major cause of maternal death Warning signs = H/A, visual changes, hyperreflexia, Abd. pain Tx = Delivery. Magnesium, Phenytoin or Diazepam, Hydralazine or Labetalol Complications of Pregnancy: UTI/Pyelo Pregnant women more prone to UTI secondary to physiologic changes of pregnancy Treat both symptomatic and asymptomatic bacturia (untreated = up to 40% risk of progression to pyelo) Culture urine, give 7 day course We admit pregnant women with pyelonephritis because of its increased risk of of progressing to preterm labor or septic shock. Complications of Pregnancy: Appendicitis Appendicitis is the most frequent surgical emergency of pregnancy Incidence is the same as non-pregnant population but the complications are more frequent secondary to delayed diagnosis Again, the physiologic changes of pregnancy complicate the clinical picture (leukocytosis, displaced appendix) Picture mimics pyelo. When patients don’t improve with IV abx, the diagnosis is reconsidered. Laparotomy is the preferred diagnostic procedure. Ultrasound can used Reference