Almost 10% of pregnant women have hypertension:Pre-existing: 1%, Gestational hypertension: 5-6%, Preeclampsia: 2% Chronic hypertension (in pregnancy): systolic BP 140+ or diastolic BP 90+ began before pregnancy – severe: if systolic…
Vital Signs: HR and BP Traditionally in medical school we were taught that physiologic changes in pregnancy caused a drop in BP and an increase in HR but generally it was not well-defined if a new range of criteria was required to be consid…
So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this… You deliver the baby flawlessly and even protect…
Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hr…
17 yo female with progestin secreting IUD, LMP 9/22/17, no prior medical problems presents to the ED with bilateral lower abdominal pain for the last day. She also notes that she has had some intermittent vaginal bleeding for the last 3 wee…
Don’t forget to consider Fitz-Hugh-Curtis Syndrome in your right upper quadrant pain differential! Fits-Hugh-Curtis Syndrome is a rare disease process characterized by perihepatitis as a complication of pelvic inflammatory dise…
Clinical Scenario: A 28-year-old G0P0, last menstrual period November 2, presents with amenorrhea. Urine pregnancy test is positive. Examination is normal. Bedside ultrasound demonstrates an early intrauterine pregnancy. After being given f…
Here are some very-quick and easy-to-read pearls to remember for the dangerous immediate postpartum complication of postpartum hemorrhage. Most common causes Uterine atony (by far) Trauma (i.e. lacerations, surgical incisions, uterin…
A 29 y/o F 20 weeks pregnant presents with fever, dysuria, and left flank pain. She has some CVA tenderness on the right. WBC is elevated to 15. UA shows both blood and leukocytes in the urine. You are concerned about pyelonephritis vs. and…
26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area. The infant is covered with a greenish liquid the consistency of split-pea soup. How do you address this?
1. What is a not a common risk factor for PID (pelvic inflammatory disease)? (a) smoking (b) tampon use (c) multiple partners (d) young age (e) IUD 2. A 19 y/o G1 presents at 34 weeks gestation with BP 170/110, headache, and mild abdominal…
22 y/o F 35 weeks gestation being treated with magnesium sulfate for preeclampsia in your ED awaiting transfer to nearby hospital for definitive care. You go to re-evaluate the patient and find her somnolent, decreased respiratory drive and…
Thank you to Papa Hernandez for this fascinating case. 37F 10 weeks pregnant (by LMP), asthma presents with 1-2 weeks of SOB. Extertional, +orthopnea, + bilateral LE edema. Has yet to initiate prenatal care. Her vitals at triage: 97…
A 32F who is 14 weeks pregnant presents with intermittent shortness of breath x 1 day. She has no h/o DVT/PE. Vitals 98.9 100 105/70 18 99% on RA. Clear lungs, no calf asymmetry on exam. You are concerned about PE. How should you procee…
Thank you to Adam Vella for inspiring this clinical question. What’s the deal with NSAIDs in pregnancy? Ibuprofen and naproxen are category B drugs in the 1st and 2nd trimesters. Catergory D in the 3rd. (aspirin is category D t…
