Medical and Perioperative Management of the Pregnant Patient


Summary
Although obstetricians play the most critical role in the health of a pregnant woman and her fetus, the internist’s skills are also often needed to assure their health. From caring for chronic medical illnesses during pregnancy to diagnosing and managing acute medical complications of pregnancy, the internist must comfortably practice obstetric medicine. The following module discusses these important topics and explains how to provide a cost-effective and evidence-based preoperative evaluation of a pregnant patient. In addition, a discussion of the use of appropriate intraoperative and postoperative interventions and methods for employing an evidence-based approach to prescribing medications in pregnant patients is included.
Goal
To provide hospitalists and other perioperative consultants with a general approach to medical and perioperative management of pregnant patients.
Target Audience
This activity is designed for hospitalists and other perioperative consultants. No prerequisites required.
Learning Objectives
After completing the module, the participant should be able to:
  1. Recognize physiologic changes of pregnancy and distinguish these from pathologic conditions.
  2. Diagnose and manage common medical complications of pregnancy.
  3. Perform a cost-effective, evidence-based preoperative evaluation of a pregnant patient.
  4. Utilize appropriate intraoperative and postoperative interventions to reduce perioperative risk in pregnant patients.
  5. Employ an appropriate, evidence-based approach to prescribing medications in pregnant patients.
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
CME Information

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide CME for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: May 15, 2009. Expiration date: May 15, 2011.

Estimated time to complete activity: 2 hours
Faculty & Faculty Disclosures
Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

*Clinical Associate Professor of Medicine, Clinical Assistant Professor of Obstetrics/Gynecology, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, New Brunswick, New Jersey; Director of Research/Outcomes, Jersey Shore University Medical Center, Department of Medicine, Neptune, New Jersey.

Conflict of Interest: Dr Carson reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Off-Label Product Discussion: Currently, no medications are approved by the US Food and Drug Administration for the treatment of pregnant women with the disorders discussed in this module. Therefore, readers are advised that the author will be discussing off-label use of various drugs.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Michael P. Carson, MD, Director of Research/Outcomes, Jersey Shore University Medical Center, Department of Medicine, Ackerman 3, 1945 Route 33, Neptune, NJ 07753. E-mail: MPCarson@meridianhealth.com.
References
Click here to download the references for this educational activity.
Instructions
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a case study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.