Emergency medicine clinics of North America
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Most postmenopausal vaginal bleeding is benign; however, it merits diagnostic evaluation by transvaginal ultrasound or endometrial biopsy after emergency department evaluation. Patients and physicians may treat menopausal symptoms with hormone replacement therapy or other agents, such as venlafaxine or gabapentin. ⋯ Pelvic organ prolapse affects millions of women and may contribute to poor body image and difficulty with urinary, gastrointestinal, and sexual function. Treatment options include Kegel exercises, pessaries, and surgery.
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Hypertension in pregnancy is increasing in prevalence and incidence and its treatment becoming more commonplace. Associated complications of pregnancy, including end-organ damage, preeclampsia, eclampsia, and postpartum eclampsia, are leading sources of maternal and fetal morbidity and mortality, requiring an emergency physician to become proficient with their identification and treatment. This article reviews hypertension in pregnancy as it relates to outcomes, with special emphasis on preeclampsia, eclampsia, and postpartum eclampsia.
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The treatment of gynecologic and other infections in obstetric patients involves consideration of the physiologic changes of pregnancy, the clinical implications of the infection for the patient as well as the fetus, and the safety of antimicrobials available for therapy. This article highlights the treatment of infections of the vagina, uterus, and urinary tract, with a focus on how therapy changes in obstetric patients. In addition, the emergency department management of other clinically important infections in pregnancy, such as those caused by the human immunodeficiency virus, influenza viruses, methicillin-resistant Staphylococcus aureus, Parvovirus, Listeria, and others is reviewed.
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Cardiovascular emergencies in pregnancy are rare but often catastrophic. This article reviews the diagnosis and management of venous thromboembolism, aortic dissection, acquired heart disease and cardiomyopathy, acute myocardial infarction, and cardiac dysrhythmias in the setting of pregnancy. It also reviews updated resuscitation guidelines for cardiac arrest and perimortem cesarean section.
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The emergency physician frequently encounters women who seek care because of pregnancy- and nonpregnancy-related complaints. Many medications are safe for use during pregnancy, including several that are listed as potential teratogens based on the Food and Drug Administration's (FDA) pregnancy classification; but it is important that the emergency physician know and recognize which drugs can be given in pregnancy and which drugs are absolutely contraindicated. Expert resources should be identified and used because the FDA's classification of drugs based on pregnancy risk does not represent the most up-to-date or accurate assessment of a drug's safety.