Part 2 book “Obstetric triage and emergency care protocols” has contents: Common general surgical emergencies in pregnancy, management of biohazardous exposure in pregnancy, sepsis in pregnancy, infections in pregnant women, intimate partner violence and sexual assault in pregnancy, sexually transmitted infections, and other contents. | IV: MANAGEMENT OF COMMON OBSTETRIC CONDITIONS THROUGHOUT PREGNANCY Common General Surgical Emergencies in Pregnancy Chelsy Caren and David Edmonson Abdominal discomfort is a common presenting complaint in pregnancy, and often has a benign, physiologic cause. However, severe pain, or pain associated with peritoneal signs on physical examination, is not considered to be normal in pregnancy. The differential diagnosis of such pain in a pregnant woman is extensive, as shown in Table , and includes both obstetric and nonobstetric conditions. Emergent general abdominal surgery is performed in approximately of pregnant women, most commonly for acute appendicitis, acute cholecystitis, and bowel obstruction (Gilo, Amini, & Landy, 2009). Following a brief discussion of general surgical considerations during pregnancy, each of these conditions is reviewed in detail. GENERAL SURGICAL CONSIDERATIONS DURING PREGNANCY Several considerations need to be taken into account during the evaluation, diagnosis, and treatment of a pregnant woman for any disorder that may require emergent surgical intervention. Foremost are the anatomic and physiologic changes that take place in a woman’s body as a result of being pregnant. These changes may alter the presentation of a given disease or make a certain diagnosis more or less likely. Obstetric complications, when present, may have an effect on these factors as well. In addition, the well-being of the fetus must be addressed throughout the encounter as well as during any surgery that is deemed necessary. This can be challenging, especially as a delay in diagnosis or treatment can jeopardize the health or life of the mother, fetus, or both. Physiologic Leukocytosis of Pregnancy A complete discussion of the pregnancy-induced anatomic and physiologic changes can be found in most general obstetric texts. The changes that are relevant to the evaluation of each surgical condition reviewed in this chapter are highlighted in the .
