How do I deal with a pregnant patient?

Every now and then, a pregnant patient shows up on a general medical floor or in the ER. And unless you’re used to taking care of pregnant women, you’re apt to feel a little out of your league. Don’t worry—the basics of care are essentially the same. The only difference is that you now have two patients instead of one.

Since your care will depend on the woman’s stage of pregnancy, ask her how far along she is. If she’s in the very early stages of pregnancy, you might not need to do anything beyond making sure her medications are safe for use in pregnancy. (Of course, you’ll also help her deal with any uncomfortable pregnancy symptoms, such as daily vomiting.) If she’s further along, you may be asked to monitor the fetus as well. If so, a Doppler stethoscope is your best bet. Simply apply the lubricating jelly to the mother’s belly and slide the Doppler along until you hear the fast, galloping heartbeat of the fetus. You’ll know you have it because it’s significantly faster than the mom’s heartbeat. Record the fetal heart rate as ordered. The mother-to-be may also be asked to provide kick counts, an assessment of the fetus’s activity over an hour or so.

Bear in mind that the physiology of a pregnant woman is somewhat different from a non-pregnant woman. Pregnancy causes a significant increase in cardiovascular volume, so you may notice a faster-than-normal maternal heart rate (about 10 to 15 beats/minute greater) and a slight decrease in blood pressure, due to decreased vascular resistance. She may also complain of shortness of breath, particularly in the later stages of pregnancy, and may void small amounts frequently. For her comfort—and her fetus’s well being—keep her off her back. The weight of the uterus can compress the vena cava, causing a decrease in blood pressure and decreased blood flow to the uterus.

Of course, certain diagnostic tests, such as abdominal x-rays, are out of the question, so make sure that all medical personnel are informed of your patient’s pregnancy. Pharmacy should be notified as well, so they can screen any prescribed medications for safety in pregnancy.