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

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 breastfeeding
    • Notable 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