Lightning Learning: Problems in Pregnancy

“Pregnant women are at increased risk of infections & sepsis. Signs & symptoms can be subtle.”

— advice is based on local guidelines & procedures

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What?

Maternal Sepsis

Pregnant women are at increased risk of infections & sepsis. Signs & symptoms can be subtle.

Ectopic Pregnancy

Classic symptoms:

• PV bleeding

• Missed period

• Abdominal pain

BUT atypical presentation is common.

Other symptoms include:

• Gastrointestinal symptoms

• Urinary symptoms

• Rectal pressure or pain on defecation

• Dizziness, fainting or syncope

• Shoulder tip pain

DON'T FORGET! The paediatric patients consider pregnancy as a possibility in peri-pubertal girls.

Why?

Of the 237 maternal deaths in the period 2010-2012, almost 25% had sepsis. In the UK there are more than 20,000 emergency admission per year due to ectopic pregnancy.

There are still 5 maternal deaths per year due to ectopic pregnancy in this country - most of these women present with atypical symptoms.

Further Reading:

• NPEU: MBRRACE-UK Reports – Improving Mothers’ Care (2014)
• NICE Guidance: Ectopic pregnancy and miscarriage: diagnosis and initial management (2012)

How?

‘Think Sepsis’ in any unwell pregnant or recently pregnant patient.

Perform a pregnancy test in any female with possible symptoms of ectopic pregnancy

Participate in simulation and review the SIM Feedback Slides and review physiological changes in pregnancy on #EM3.

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For more details on eclampsia:

The Skeptics Guide to Emergency Medicine (SGEM) - Podcast #11: All Seizures Stop…Eventually (Magnesium and Eclampsia) you can read the blog post or listen to the podcast.