- Since preeclampsia is present in up to 7% of pregnancies, always check the blood pressure and screen for proteinuria.
- HELLP syndrome includes hemolysis, elevated liver enzymes, and low platelet counts; the lower the platelet count, the higher the mortality.
- Bleeding in the first trimester should alert the physician to ectopic pregnancy or threatened/spontaneous abortion. In later trimesters, consider placenta previa and abruption.
- With placenta previa, examination of the cervix can exacerbate hemorrhage.
- Placental abruption classically presents with vaginal bleeding, abdominal pain, uterine tenderness, and contractions. Bleeding may be concealed and does not correlate with severity of abruption.
- Ultrasonography is insensitive and unreliable for diagnosis of placental abruption.
- Ectopic pregnancy is the leading cause of maternal mortality during the first half of pregnancy in the United States, and should be suspected in any patient with abdominal pain and vaginal bleeding.
- Symptomatic deep vein thrombosis may be difficult to diagnose clinically because the pregnant patient often has leg swelling and discomfort during normal pregnancy.
- In the pregnant trauma patient, shock may be difficult to diagnose because during pregnancy, blood volume is increased, as is respiratory rate and heart rate.
Teenage pregnancies and children born to adolescents have a great impact on society. Pregnant teens are less likely to receive prenatal care and are more likely to partake in high-risk behaviors such as smoking and consumption of alcohol during pregnancy. Teen mothers are at risk of not completing their education and living in poverty as compared to their peers.
Although the overall rate of teenage pregnancy has declined over the past decade, there are still more than 850 000 teen pregnancies a year.1 From 1990 to 2002, the teen pregnancy rate decreased from 38.6 to 21.4 per 1000 pregnancies. Although this is a significant improvement, certain ethnic groups continue to have a disproportionately high incidence of pregnancy in teens, from ages 15 to 17 years. The non-Hispanic black and Hispanic teenagers continue to have greater than 85 per 1000 pregnancies in this age group, as compared to non-Hispanic white teens who average 25 per 1000.2 The decline in teen pregnancy is due to an increase in the use of contraception, a decrease in sexual activity, and effective pregnancy prevention programs.3
Emergency medicine physicians who routinely care for adolescents must therefore have the basic knowledge and skills to care for the adolescent pregnant patient, as well as resources to ensure appropriate treatment and follow-up. It is important that the emergency physician be able to recognize, stabilize, and treat complications of pregnancy, to recognize signs and symptoms that require immediate obstetrical referral, and to access appropriate and timely medical follow-up and resources unique to the needs of the adolescent patient.
Preeclampsia, or toxemia of pregnancy, complicates 2% to 7% of all pregnancies.4 Preeclampsia is defined as hypertension with a blood pressure of 140/90 mm Hg or greater associated with proteinuria, and/or edema during pregnancy greater than 20 weeks ...