The Acute Physician's Approach to the Pregnant Patient, Dr Anita Banerjee PDF
Preview The Acute Physician's Approach to the Pregnant Patient, Dr Anita Banerjee
The Acute Physician’s Approach to the Pregnant Patient Anita Banerjee Acute Physician Obstetric Physician The Society for Acute Medicine, 7th International Conference, 3-4 October 2013 What we need to know? • Which physiological adaptations occur during pregnancy • Women with pre-existing chronic conditions may worsen • Which investigations are safe in pregnancy • Which drugs are safe in pregnancy Direct and Indirect Maternal Death Rates UK 1985-2008 16 14 12 10 8 6 4 2 0 9 0 3 6 9 2 5 8 5-8 8-9 1-9 4-9 7-9 0-0 03- 6-0 8 8 9 9 9 0 0 0 2 0 2 Direct Indirect Total The Eighth Report of the UK Confidential Enquiries into Maternal Deaths Leading Causes of Maternal Deaths 2006-08 UK 2.50 MEDICAL PROBLEMS 2.00 s IN PREGNANCY e i t i n r e Women were more obese t a 1.50 m 0 0 0 , 0 0 1 1.00 r e p e t a R 0.50 0.00 esaesid caidraC tceridnI rehtO* sesuac tceridnI lacigoloruen *snoitidnoc sispeS aispmaelcrPe- dna sisobmorhT msilobmeobmorht diulf citoinmA msilobme sesuac cirtaihcysP ycnangerp ylraE shtaed egahrromeaH aisehtseanA **tceriD rehtO tceridnI seicnangilam Medical Emergencies in Pregnancy Pre-existing Pregnancy-specific Asthma exacerbation Pre-eclampsia Hypertension Venous thromboembolism Diabetes, Thyroid Gestational Diabetes SLE, RA Obstetric Cholestasis AKI Hyperemesis Cardiac arrest Acute Fatty Liver Heart failure Aortic dissection What changes occur during pregnancy? Haematological Metabolism Cardiovascular Respiratory Neuromuscular Renal What changes occur during pregnancy? Respiratory Rise in O2 Consumption Case 32 years Primgravid 27/40 gestation singleton c/o Breathless What tests would HR 108 beats/min Sats 94% RA you like to do? BP 102/66 mmHg Past Medical History Asthma Case Arterial Blood Gas 32 years pH 7.31 Primgravid 27/40 gestation singleton PCO 4.1 2 P0 9 2 c/o Breathless HCO3- 14 HR 108 beats/min BE -5 Sats 94% RA BP 102/66 mmHg Peak Flow 210 Past Medical History Asthma Case Arterial Blood Gas 32 years pH 7.31 7.40-7.47 Primgravid PCO 4.1 3.38 27/40 gestation singleton 2 P0 9 13.5 2 c/o Breathless HCO3- 14 18-22 HR 108 beats/min BE -5 0 Sats 94% RA BP 102/66 mmHg Peak Flow 210 Past Medical History Asthma PEAK FLOW DOES NOT CHANGE
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