Search

Trauma is the leading cause of non-pregnancy-related maternal death in the United States. Despite advances in treatment maternal and fetal outcomes are often poor. Women of childbearing age sustaining traumatic injury should be evaluated for possible pregnancy. Physiologic changes of pregnancy influence the evaluation and management of trauma. Medical treatment should be guided by maternal needs in order to optimize maternal and fetal outcomes. Maternal cardiac arrest should prompt consideration of emergent cesarean section. Anesthesiologists play a critical role in integrating the physiology of pregnancy with life support and trauma protocols and can help reduce morbidity and mortality.

This case describes a pregnant patient who presented prior to delivery with an unspecified cardiac condition that was determined to be severe mitral stenosis Although a scheduled cesarean section was planned, the patient presented prior to the planned procedure in active labor with uncontrolled pain. Management of this patient, the pathophysiology of mitral stenosis, and considerations relevant to this condition in pregnancy are discussed.

Urologic emergencies and other medical conditions requiring surgery are not uncommon during pregnancy. Appendicitis, cholecystitis, ovarian cysts, and pregnancy-related conditions remote from term, such as incomplete abortions and cervical incompetence, comprise the majority of complications requiring surgery during pregnancy, although urolithiasis, tumors of the urinary tract, and peripartum urologic complications also occasionally require emergency intervention

Nephrolithiasis in Adults Low radiation dose, noncontrast-enhanced computed tomography (MDCT) with 2.5-mm image reconstruction in at least one plane is the test of choice for the patient with a suspected obstructing ureteral stone. In the absence of an available MDCT scanner, intravenous urography (IVU) or a combination of plain radiograph (KUB) and ultrasonography (US) should be performed (moderate evidence). Plain radiograph may be used to follow the descent of stones along the ureter (moderate evidence). For the pregnant patient when US is not diagnostic, MRI avoids ionizing radiation and may be useful with suspected nephroureterolithiasis (insufficient evidence).

The pregnant state provides unique challenges to the breast specialist attempting to perform clinical breast evaluation as the hormonal changes of pregnancy cause breast tissue to undergo significant physiologic alterations. For this reason, it would be ideal to perform a baseline clinical breast examination as soon as pregnancy is established. Most commonly the first opportunity for the baseline clinical breast exam is at the first obstetric visit, which is also acceptable, as the breast tissue has undergone minimal change by then. This baseline evaluation facilitates evaluation of any subsequent changes, physiologic or pathologic, which may occur during pregnancy. This chapter outlines strategies for evaluating the gravid patient including the timing of diagnostic and therapeutic interventions for those suspected of having or diagnosed with breast cancer.

The management of a critically ill patient that is pregnant is complex. The illness that places a patient in the ICU may be due to pregnancy itself or underlying medical diseases. Pregnancy-induced hypertension and amniotic fluid embolism are extensively covered in this chapter. Several tables depict information for rapid reading and understanding useful facts and formulas in the pregnant patient.

One of the greatest challenges that confront the surgeon is the care of the pregnant patient. Outcomes of disease management affect two patients, both the mother and the fetus. In addition, physiological changes during pregnancy alter classic complaints, presentations, and treatments. Abdominal emergencies in the gravid woman are frequently difficult to diagnose, and management of cases that are straightforward in the nonpregnant patient become complicated in the pregnant state.

Malpractice lawsuits charging that an abortion or fetal anomaly was caused by exposure to diagnostic radiation are infrequent. Nevertheless, radiologists should make every effort to decrease the likelihood of exposing an unknowingly pregnant woman to radiation in order to prevent clinical danger to the fetus and any potential legal liability.1

Cancer of the breast is the most common invasive cancer in women, now estimated to develop, during her lifetime, in one of every nine women. As many as 15% of breast cancers present during the childbearing years. The most common cancer in pregnant women is breast cancer; and although it occurs rarely, it causes significant emotional issues for all involved. Moreover, the clinical challenge is often greater than with nonpregnant women. Finally, because physicians deal with this situation so infrequently, it is easy to propagate misinformation.

Traumatic injuries are estimated to occur in 6 to 8% of all pregnancies1–3 and are the most frequent cause of nonobstetric death during pregnancy.4,5 Trauma is the leading cause of death in patients under the age of 40 years,6 and the pregnant patient does not appear to be protected from traumatic insults.7 In today’s society the pregnant woman maintains her activity and frequently rides and drives in motor vehicles during her entire pregnancy. Motor vehicle collisions are the leading cause of trauma in this group5 and are responsible for ten times the number of deaths than from all other causes combined.8

The family physician has a unique role in the care of the pregnant patient. With knowledge of the patient’s family dynamics, living Situation, and social support system, the family physician provides prenatal care focused toward a healthy birth and the development of a nurturing family unit.