Third Trimester and Post Partum Disasters ACEP Spring Congress 2007 Jason Knight, MD Maricopa Medical Center Department of Emergency Medicine Phoenix, AZ Third trimester and postpartum complications can be stressful and challenging patient encounters. Prompt recognition and treatment of these emergencies are essential to decrease maternal and fetal morbidity and mortality. The speaker will highlight the presenting symptoms and the latest advances in the treatment of preeclampsia, eclampsia, HELLP syndrome, preterm labor, premature rupture of membranes, placental abruption, placenta previa, postpartum hemorrhage, and endometritis. The speaker will also briefly cover fetal monitoring, cardiomyopathy, pulmonary embolism and appendicitis. Lecture Objectives 1. Review the recognition, evaluation, and management of third-trimester and postpartum complications. 2. Discuss the most recent literature in third trimester and post partum emergencies. 3. Review Maternal Fetal Monitoring 1 ; Preeclampsia Eclampsia Introduction Multisystem disease of unknown etiology 5-7% of pregnancies Significant cause of maternal and fetal morbidity and mortality Definition: Blood Pressure 140 90 after 20 weeks gestation Proteinuria 0.3 gms 24 hours Eclampsia preeclampsia + seizures Severe preeclampsia: when any of the following are presentBP 160-180 systolic or 110 diastolic Decreased urine output 500 cc in 24 hours ; Visual disturbances Abnormal liver function tests Intrauterine Fetal Growth Retardation Pulmonary edema Seizures eclampsia ; Significant proteinuria: 5 gms per 24 hours ; -Adapted from ACOG Technical Bulletin 219, 1996.
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[1] The European Agency for the Evaluation of Medicinal Products EMEA ; Note for Guidance on the Investigation of Drug Interactions CPMP EWP 560 95, 1997. [2] U.S Food and Drug Administration U.S. FDA ; : Guidance for Industry, Drug Metabolism Drug Interaction Studies in the Drug Development Process: Studies In Vitro. CDER, 1997. [3] Jeppesen et al., 1996. Pharmacogenetics 6, 213-222. [4] Bonati et al., 1982. Clin.Pharmacol.Ther. 32, 98-106. [5] Tang-Liu et al., 1983. J.Pharm.Exp.Ther., 224, 180-185. [6] Spigset et al., 1997. Eur.J.Clin.Pharmacol. 52, 129-133. [7] Jan et al., 2002. Drug Metabol.Drug Interact. 19, 1-11.
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Figure 14. Top therapeutic classes contributing to pharmacy spending for specialty drugs in 2003.
Privacy & Security Domains - #2: Information Authorization and Access Controls - #9: Information Use & Disclosure Policies Critical Observations While many organizations are currently engaged in planning and early implementation of RHIOs, very few in the State are currently exchanging data. For this reason, few stakeholders were able to offer business practices in response to this scenario. Most stakeholders agreed, however, that the exchange of patientidentified health information between providers and a RHIO for quality monitoring purposes would require the affirmative consent of the patient, and that special consent would be necessary to include information related to any sensitive health needs. New York law lacks any specific regulatory guidance for RHIOs, leaving organizations to make judgment calls on a case-by-case basis, considering the nature and scope of such consent. It is likely that the consent would need to be carefully crafted to ensure that the patient understood the nature and scope of the release, as RHIO activities are beyond what most patients would anticipate when signing a general consent for release of health information for treatment and payment purposes and lozol, because pm.
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Election of Officers Hemant Patel has been re-elected President of the Society. Martin Astbury is the new Vice-President and Andrew Gush is the new Treasurer p687 ; . "Responsible pharmacist" The Society is seeking members' views on the concept of the "responsible pharmacist" p688.
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