Guidelines for Pregnant Patients

Acute Cystitis:

  • Significantly increased prevalence in pregnancy  
  • Symptoms: dysuria (urgency/frequency common in pregnancy)  
  • Diagnosis: evidence of pyuria and >103 cfu/ml (note, if neg would test for g/c) 
  • Treatment: same as asymptomatic bacteriuria  

 

Pyelonephritis: 

  • Symptoms: fever, flank pain, and nausea/vomiting, dysuria 
  • Diagnosis: clinical suspicion + pyuria and bacteriuria 
  • Treatment: IV antibiotics for 1st 24-48hrs; beta-lactams preferred 
  • Mild to moderate: ceftriaxone or cefepime 
  • Moderate to severe: piperacillin-tazobactam or meropenem  

 

Hyperemesis Gravidarum: 

  • Presentation: Hormone mediated nausea/vomiting typically starting before 9wks GA 
  • Differential: gastroenteritis, hepatitis, biliary tract disease, obstruction, pancreatitis, pyelonephritis, nephrolithiasis, ovarian torsion, DKA, hyperparathyroidism, migraines, preeclampsia 
  • Workup: BMP, mg, phos, LFTs, lipase (may be mildly elevated in HG), UA,  
  • Treatment:  
      • First Line: Ginger, doxylamine (25mg PO q6), pyridoxine (20mg PO q6) 
      • Second Line: metoclopramide (10mg q6), Promethazine (12.5mg q6)  
      • Third Line: ondansetron (8mg q12hrs, after 1st trimester)   
      • Hydration: 1L LR on admission + banana bag q24hrs 

 

Hypertension:  

  • Both gestational HTN and preeclampsia/HELLP are typically diagnosed >20w GA 
  • Tx options: nifedipine, labetalol, methyldopa, hydral (2nd line), clonidine (2nd line) 
  • Avoid: ACEs, ARBs, MRAs, Nitroprusside 

 

Diabetes:

  • Due to hormonal changes associated with pregnancy, pregnant patients are at higher risk for poor control and DKA
  • Oral regimens are generally transitioned to insulin-based regimens.  

 

GERD:  

  • 1st Line: Can use antacids; avoid sodium bicarbonate and magnesium trisilicate  
  • 2nd Line: Sucralfate 1g PO TID 
  • 3rd Line: Cimetidine 200mg (30min prior to eating) 

 

Asthma:

  • Similar rescue and controller medications as in non-pregnant patient
  • Would favor using LABA over leukotriene receptor antagonists or theophylline for additional therapy