10 Important Pregnancy Facts | The EM & Acute Care Course

Pregnancy Facts by Rick Pescatore, DO

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Key Points and Recommendations:

1. Longer working hours reported in the first trimester are associated with pregnancy complications.

2. In pregnant women with abdominal pain or vaginal bleeding, there is insufficient evidence to state equivalence between groups who did and did not receive a pelvic exam in terms of a composite mortality endpoint at 30 days.
Longer working hours reported in the first trimester are associated with pregnancy complications.

3. Asymptomatic patients greater than 20 weeks gestation should have fetal and uterine monitoring for several hours after minor trauma to evaluate for placental abruption or injury to the fetus. Current evidence does not support admission for 24 hours unless there is uterine tenderness, significant abdominal pain, vaginal bleeding, uterine contractions, rupture of membranes, abnormal fetal heart rate pattern, a high-risk mechanism, or a positive fibronectin test.

4. An advantage of a tetanus booster during pregnancy is that it increases pertussis antibodies in the mother which can be passed on to the child and potentially decrease the risk of pertussis in the infant.

5. There is some preliminary data to suggest there might be an association between acetaminophen during pregnancy and hyperactivity and symptoms of autism spectrum conditions in the offspring, but it is retrospective and might be confounded by a number of other genetic and environmental variables.

6. Fetal radiation doses of less than 50 mGy are not associated with increased fetal anomalies or fetal loss throughout pregnancy. The radiation doses of essentially all diagnostic imaging examinations using ionizing radiation used in a trauma evaluation should be well below this threshold.

7. Current first-line recommendations for nausea and vomiting in pregnancy include treatment with pyridoxine (vitamin B6) alone or with doxylamine. The use of ondansetron during early pregnancy might be associated with a small risk of fetal malformations and the relative safety of ondansetron in early pregnancy is unclear. The current recommendations suggest that it be reserved for pregnant patients in whom other agents have failed.

8.Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and a lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.

9. Administration of supplemental oxygen to women in labor may have adverse effects to the fetus and should be limited to cases of maternal hypoxia or cases of non-reassuring fetal heart rate activity.

10. TXA may reduce the incidence of postpartum hemorrhage without increasing the risk of thromboembolism and should be given as early as possible to maximize benefit.


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