Females < 18 yrs with Behavioral Health Concerns and Pregnancy — Complications of Pregnancy — Clinical Pathway: Emergency Department

Behavioral Health Concerns and Pregnancy, Females < 18 yrs — Clinical Pathway

Complications of Pregnancy

Ectopic
  • Lower abdominal pain
  • Bleeding may or may not be present
  • Shock symptoms
Septic Abortion
  • Uterine infection following loss/termination
  • Abdominal pain, uterine tenderness
  • Purulent vaginal discharge, bleeding
  • Sepsis Pathway, broad-spectrum antibiotics with anaerobic coverage
  • Surgical source control
Miscarriage
  • Loss of pregnancy before 20 wks
  • Crampy abdominal pain, vaginal spotting/bleeding
Placental Previa Bright red vaginal bleeding may be painless or associated with contractions
Placental Abruption
  • Dark vaginal bleeding, abdominal or back pain
  • Uterine tenderness and rigidity, contractions
Pregnancy-related Liver Disease
  • Epigastric or RUQ pain overlaps between syndromes below
  • Preeclampsia
    • New hypertension, proteinuria after 20 wks
  • HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelets)
    • Non-specific symptoms, malaise, nausea, vomiting
    • Hemolysis w/microangiopathic blood smear
    • Elevated LFTs, low platelet count
  • Acute Fatty Liver
    • 3rd trimester, nausea, vomiting, abdominal pain
    • Jaundice
    • Majority have preeclampsia at presentation
PID Pelvic Inflammatory Disease
Labor
  • Uterine contractions occurring with increasing frequency, intensity and duration
  • Result in cervical dilation
  • Associated light vaginal bleeding or Associated light vaginal bleeding or rupture of membranes (ROM)
  • Pre-term 20 to < 37 wks, term ≥ 37 wks