Episode 7: Medical and Surgical Emergencies in Pregnancy

Managing medical and surgical emergencies in pregnant patients requires recognizing that pregnancy-induced physiological changes often mask or mimic critical conditions. Pulmonary embolism (PE) remains a top concern, where D-dimer testing lacks utility due to elevated baseline levels; instead, bilateral leg dopplers serve as an initial diagnostic step, with definitive imaging chosen based on radiation risk profiles. In cases of maternal cardiac arrest, early defibrillation is safe, and emergency C-section within four minutes can significantly improve maternal hemodynamics. Appendicitis presents diagnostic challenges due to atypical symptoms and delayed peritoneal signs, necessitating early surgical consultation and imaging to prevent high rates of fetal loss and maternal mortality associated with perforation. Furthermore, asymptomatic bacteriuria and cystitis require aggressive antibiotic treatment, such as nitrofurantoin or cephalosporins, to mitigate the increased risk of progression to pyelonephritis and subsequent preterm labor.