Emergency Department Management of Obstetric Complications

Emergency Department Management of Obstetric Complications

Joelle Borhart Editor Emergency Department Management of Obstetric Complications

Editor Joelle Borhart MedStar Georgetown University Hospital and MedStar Washington Hospital Center Georgetown University School of Medicine Washington, DC USA ISBN 978-3-319-54409-0 DOI 10.1007/978-3-319-54410-6 ISBN 978-3-319-54410-6 (ebook) Library of Congress Control Number: 2017939688 Springer International Publishing AG 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface Obstetrical emergencies can be among the most stressful events an emergency physician will face in their entire career. Late pregnancy bleeding or a precipitous emergency department (ED) delivery can provoke anxiety in even the most seasoned emergency physician. Trauma and cardiovascular emergencies in pregnant patients can result in catastrophic outcomes for both mother and baby. When it comes to pregnant patients, even seemingly minor presentations such as trip and fall can become an area of treachery. The goal of this book is to provide an evidence-based, practical approach to the wide spectrum of obstetric complications an emergency physician must be prepared to manage throughout all trimesters of pregnancy as well as postpartum. The approach to the pregnant patient with trauma, with non-pregnancy-related abdominal pain, or in cardiac arrest is discussed. Updates in the classification and management of the hypertensive disorders of pregnancy are presented. Recent controversies surrounding the use of antiemetics for first-trimester nausea and vomiting and the use of a beta-hcg discriminatory zone for the evaluation of pregnancy of unknown location are also addressed. This book is written for emergency clinicians in all practice settings. Obstetrical support services vary widely between different facilities, and emergency physicians must be prepared to initially manage any pregnant patient that comes through the door. It is my hope that this book provides useful information for daily practice as well as preparation for rarely encountered and potentially life-threatening events. The departmental leadership of the MedStar Georgetown University and MedStar Washington Hospital Center Emergency Departments was incredibly supportive of this project, and I am grateful for their assistance. I would like to thank the Emergency Medicine Residency Program faculty and residents for their contributions, encouragement, and friendship. The authors of all the chapters deserve recognition for their outstanding contributions to this text. My son Sean, born during the production of this book, has been a source of inspiration, joy, and reminder of what is most important in life. Finally, I must thank my husband, Steve you took on far more than your share of household duties and childcare to allow me the time to v

vi Preface complete this project. Without your support, this book would not have been possible. Emergency physicians are in a unique position to have a potentially tremendous impact on the life of a pregnant patient and her unborn child. I hope that this book equips you with the tools to provide the best possible care for your obstetric patients in the ED each and every day. Washington, DC Joelle Borhart, M.D., F.A.C.E.P., F.A.A.E.M.

Contents 1 Early Pregnancy Complications................................ 1 Kayla Dewey, Kathryn Voss, and Carolyn Phillips 2 Emergency Department Ultrasound in Pregnancy................ 15 Cory Wittrock and Erica Peethumnongsin 3 Approach to the Patient with Nausea and Vomiting in Pregnancy... 31 Lindsey DeGeorge and Lauren Wiesner 4 Hypertensive Disorders of Pregnancy........................... 41 Whitney Sherman, Edward Descallar, and Joelle Borhart 5 Bleeding in Late Pregnancy................................... 53 Maria Dynin and David R. Lane 6 Premature Rupture of Membranes and Preterm Labor............ 63 Eric Wei, Lili Sheibani, and Brian Sharp 7 Precipitous Labor and Emergency Department Delivery........... 75 Brian Sharp, Kristen Sharp, and Eric Wei 8 Evaluation and Treatment of Postpartum Hemorrhage............ 91 Elaine Bromberek and Janet Smereck 9 Cardiovascular Emergencies of Pregnancy..................... 105 Lisel Curtis and Nick Tsipis 10 Cardiac Arrest in the Pregnant Patient........................ 117 Jessica Palmer, Marianne Wallis, and Joelle Borhart 11 Trauma in Pregnancy....................................... 129 Marcos Mavromaras, Christina Bird, Julie Gorchynski, and Linda Hatch vii

viii Contents 12 Non-obstetric Abdominal Pain in Pregnancy.................... 143 Mallory Shasteen and Elizabeth Pontius 13 Imaging Considerations in Pregnancy......................... 159 Diana Ladkany and Kerri Layman Index......................................................... 169

List of Contributors Elaine Bromberek, M.D. Department of Emergency Medicine, MedStar Georgetown University and MedStar Washington Hospital Center, Washington, DC, USA Christina Bird, D.O. Department of Emergency Medicine, UT Health Science Center, San Antonio, TX, USA Joelle Borhart, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Lisel Curtis, M.D Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA Lindsey DeGeorge, M.D. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA Edward Descallar, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Kayla Dewey, M.D. Department of Emergency Medicine, MedStar Washington Hospital Center and MedStar Georgetown University, Washington, DC, USA Maria Dynin, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA Julie Gorchynski, M.D. Department of Emergency Medicine, UT Health Science Center, San Antonio, TX, USA Linda Hatch, M.D. Department of Emergency Medicine, UT Health Science Center, San Antonio, TX, USA Diana Ladkany, B.S., M.D. Department of Emergency Medicine, MedStar Washington Hospital Center and MedStar Georgetown University, Washington, DC, USA David R. Lane, M.D. Department of Emergency Medicine, MedStar Southern Maryland Hospital Center, Clinton, MD, USA ix

x List of Contributors Kerri Layman, B.S.F.S., M.D., R.D.M.S Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Marcos Mavromaras, M.D. Department of Emergency Medicine, UT Health Science Center, San Antonio, TX, USA Jessica Palmer, M.D. Department of Emergency Medicine, MedStar Southern Maryland Hospital, Clinton, MD, USA Erica Peethumnongsin, M.D. Division of Emergency Medicine, Department of Surgery, Duke University Hospital, Durham, NC, USA Carolyn Phillips, M.D., R.D.M.S. Department of Emergency Medicine, MedStar Washington Hospital Center and MedStar Georgetown University, Washington, DC, USA Elizabeth Pontius, M.D., R.D.M.S. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA Brian Sharp, M.D., F.A.C.E.P. BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA Kristen Sharp, M.D. Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA Mallory Shasteen, M.D. Department of Emergency Medicine, Greenville Hospital System, Greenville, SC, USA Lili Sheibani, M.D. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, USC, Los Angeles, CA, USA Whitney Sherman, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Janet Smereck, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA Nick Tsipis, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Kathryn Voss, M.D. Department of Emergency Medicine, MedStar Washington Hospital Center and MedStar Georgetown University, Washington, DC, USA Marianne Wallis, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA Eric Wei, M.D., M.B.A. Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, CA, USA Lauren Wiesner, M.D. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA Cory Wittrock, M.D. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA