The Acute Physician's Approach to the Pregnant Patient, Dr Anita Banerjee

36 Pages·2013·1.18 MB·English

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
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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