How to Care for Pregnant and Lactating Patients in Non-Obstetric Departments with Dr. Michelle Solone

Pregnant and breastfeeding patients aren't always hospitalized for obstetric reasons and can be placed throughout the hospital. Dr. Michelle Solone, OBGYN talks to us about how we can assess these patients, what to look out for, and how nurses can promote pumping and breastfeeding during a hospitalization.
Common reasons for non-OBGYN related hospitalization for pregnant patients:

Medical: Kidney Stones, Chemo, Pyelonephritis, Cardiac Conditions

Surgical: Cholecystitis, Appendicitis

Trauma

Which floor does the Pregnant Patient receive care on?

Less than 20 weeks → regular medical floor

20 weeks & up → Labor & Delivery Floor

Situational Examples:  
L&D Nurses don't interpret EKG's, which will influence which floor a patient can be assigned → CCU/ICU

ED for asthma exacerbation, traumas

Respiratory Distress/IV Drip Monitoring →need ICU nurse with L&D Nurse present to monitor baby

Physiologic Differences of Pregnant Patients

Increased Blood Volume which can lead to dilutional anemia (ex: Hct 34), due to plasma>RBCs

Increased Cardiac Output and decreased vascular resistance (↓BP)

CPR: Left lateral decubitus positioning or Left Uterine displacement for CPR over 20 weeks →Have mom supine, and have a coworker push the uterus about 2 inches over to the Left side for circulation return

Increased WBCs

Decreased lung capacity, but increased tidal volume (RR should be same)

Increased risk for VTE 
Nursing Interventions: SCD's, mobilization, sleep on left side

Medical Intervention: Lovenox, Heparin

Increased GFR →some medications may need adjustments/labs

Assessment ABC's of Pregnancy

A. Amniotic Fluid

B. Bleeding (never normal, need OBGYN at bedside)

C. Contractions/Abdominal Pain

D. Dysuria

E. Edema (DVT or Pre-Eclampsia)

F. Fetal Movement

Medications and Imaging in Pregnancy

There is a fear of giving moms pain medications, but most narcotics are safe in short term, such as with kidney stones. Chronic use would be of concern.

Antibiotics such as Vancomycin and Ampicillin are very common for the treatment of infection in pregnant patients

Imaging is safe 
Preference →ultrasound to avoid radiation, followed by MRI (no gadolinium) if needed

CT (with or without contrast) is also safe

Care of the Postpartum and Lactating Patient

Important: Advocate for breastfeeding and Pumping! 
Get a Pump in the room early on!

Save ALL milk → DON'T DUMP Unnecessarily Label milk to later review with MD if safe for baby

What meds are compatible with breastfeeding? 
Almost all medications are compatible with breastfeedingNotable exception: Codeine/Tramadol (such as Tylenol with Codeine)

Regular Tylenol and Motrin safe for Postpartum Patients

Physiological Changes in Postpartum 
Fluid Shifts: all blood from uterus rush and return back to heart → flash pulmonary edema, fluid overload within 24 hrs after delivery

Preeclampsia may present after delivery

Anemia →PP mom may need blood transfusions/iron