This is a talk I gave recently for our registrar teaching morning. Not the sexiest presentation (forgive the bullets) but hopefully will give you the basic, textbook level info a al foamcast style

1. medical complications
of pregnancy
Emergency
FCEM

2. Molar Pregnancy
http://radiopaedia.org/articles/hydatidiform-mole
Emergency

3. Emergency
useful facts
gestational trophoblastic disease
!
20% malignancy
!
presentation
• probably 2nd trimester for us
• higher HCG than expected
• bigger fundus than expected
• more hyperemesis
• preecmampsia (even <24 wks)

4. amniotic fluid embolus
• mixing of amniotic fuid into systemic circulation
• during labour or manipulation [can be spontaneous]
Emergency
looks like
sudden onset
• low BP
• hypoxia
• coagulopathy
https://en.wikipedia.• seizures in about org/wiki/10%
Allergy#mediaviewer/File:The_Allergy_Pathway.jpg
anaphylactoid NOT obstructive

5. pregnancy induced hypertension
• gestational hypertension = BP>140/90
• preeclampsia = BP>140/90 and proteinuria
• eclampsia = seizures with preeclampsia
Emergency
https://en.wikipedia.org/wiki/Hypertension#mediaviewer/File:Grade_1_hypertension.jpg

6. Emergency
why?
• “vasospastic disease”
• likely endogenous pressers
• high cardiac output with high resistance

7. Emergency
diagnosis
Systolic ≥140 mmHg or diastolic ≥90 mmHg, and
•Proteinuria ≥0.3 grams in a 24-hour urine specimen or
protein:creatinine ratio ≥0.3, or
•Signs of end-organ dysfunction (platelet count
<100,000/microliter, serum creatinine >1.1 mg/dL or
doubling of the serum creatinine, elevated serum
transaminases to twice normal concentration)
http://www.nice.org.uk/guidance/cg107/resources/guidance-hypertension-
in-pregnancy-pdf

8. what should you examine?
• pressure [NB >160/110 considered severe]
• protein
• oedema
• mental status
• reflexes/clonus
• liver tenderness
• jaundice
• headache/visual probs [big red flag]
Emergency

9. Emergency
H
E
L
L
P
aemolysis
levated
iver enzymes
ow
latelet count

10. what HELLP can look like
• TTP
• Acute fatty liver of pregnancy
• Lupus
• Sepsis
Emergency

11. it’s pre-eclampsia so what now?
Emergency
• IV access/monitor
• check labs
• urine dip
• FBC [anaemia and low platelets. <100 a sign of severe]
• renal [often AKI]
• LFTs [ALT/AST/bili]
• Clotting [should be normal]
• Mag [as baseline]
• ultrasound [how big is the baby?]
• give magnesium
• give labetalol

12. Emergency
magnesium
http://www.nice.org.uk/guidance/cg107/resources/guidance-hypertension-
in-pregnancy-pdf
keep giving it till the reflexes disappear…

13. don’t forget
http://www.nice.org.uk/guidance/cg107/resources/guidance-hypertension-
in-pregnancy-pdf
Emergency

14. abdo pain in pregnancy
Emergency
bump related
• preeclampsia
• miscarriage/labour
non-bump related
• gallbladder
• appendicitis
• UTI

15. Emergency
appendicitis
• commonest surgical emergency
• difficult to diagnose (up to 50% normal appendicectomy, up to 25% perforation)
• most consistent feature is right sided pain
• big issues if missed
imaging
• ultrasound first
• CT or MRI if ultrasound equivocal

16. Emergency
gallbladder
• similar symptoms to non pregnant
• ALP normally up in pregnancy, as is amylase and WCC…
• ultrasound is key
much more importantly
• is this HELLP?
• is this preeclampsia
• is this fatty liver of pregnancy?

17. Emergency
UTI
the exception to the rule about asymptomatic bacteruria
http://www.sign.ac.uk/pdf/sign88.pdf

18. headache in pregnancy
• is this SAH?
• is this preeclampsia?
• migraine frequency typically becomes less
• tension headaches typically no change
Emergency

19. image credit: Jeremy Jones http://radiopaedia.org/cases/venous-sinus-Ethmroemrgbeonscisy

20. cerebral venous sinus thrombosis
Emergency
immediately post partum
!
usually presents
• headache
• stroke
• seizures
• reduced LOC
CT
• delta sign
• venous infarction
• venous bleeding
management
• anticoagulation

21. chest pain/SOB in pregnancy
• ACS
• PE [though we probably overinvestigate]
• dissection [commonest during labour]
• cardiomyopathy
• dyspnoea of pregnancy
Emergency

22. http://www.ncbi.nlm.nih.gov/pubmed/2Em5er2ge6nc9y575

23. “Cardiac disease is the leading cause of
death in pregnancy and the puerperium
in the UK, and was responsible for 20%
of the maternal deaths between 2006 and
2008. Ischaemic heart disease and
myocardial infarction (MI) are the most
common pathologies, being the cause of
20% of the maternal cardiac deaths”
Heart 2012;98:10 760-761 doi:10.1136/heartjnl-2011-301564
Emergency

24. Emergency
• usual symptoms
• 75% STEMI
• Most anterior
• PCI/CABG preferred
• lytics up to 8% bleeding
• give aspirin and your anti platelet of choice
• nitrates prob fine

25. meadow’s syndrome
zaria syndrome
Emergency

26. 2010 ESC Working Group defined PPCM as an idiopathic
cardiomyopathy with the following characteristics:
!
●Development of heart failure (HF) toward the end of
pregnancy or in the months following delivery
●Absence of another identifiable cause for the HF
●Left ventricular (LV) systolic dysfunction with an LV ejection
fraction (LVEF) nearly always less than 45 percent. The left
ventricle may or may not be dilated.
Emergency

27. fin
Emergency