OB

Contraindications to estrogen-containing contraceptives include migraine with aura, history of breast cancer, venous thromboembolic disease, uncontrolled hypertension, or smoking more than 15 cigarettes a day for women older than 35 years.

Non-estrogen hormonal contraception options are levonorgestrel-releasing intrauterine devices (IUDs), subdermal progestin implant, depot medroxyprogesterone acetate injection, and progesterone-only oral contraceptive pills; a copper IUD is a nonhormonal option

2022 ACG Monograph on GI Diseases and Endoscopy in Pregnancy and Postpartum Period

Table of Contents:

Hyperemesis Gravidarum and Nutritional Support

Heartburn, Nausea, and Vomiting During Pregnancy

Constipation, Hemorrhoids, and Anorectal Disorders in Pregnancy

Fecal Incontinence and Diarrhea During Pregnancy

Endoscopy and Sedation

Advanced Endoscopic Procedures in Pregnancy

Liver Disease During Pregnancy

Surgery in Pregnancy

Inflammatory Bowel Disease and Pregnancy

#Hyperemesis Gravidarum (ACG monograph)

Weight loss >5%

History of chronic n/v?

Suicidal ideation?

-referral to behavioral health

r/o bowel obstruction, IBD, gastroenteritis, PUD, delayed gastric emptying, acute chole, acute panc, AI, DKA, thyrotoxicosis, CNS mass/hemorrhage/migraine, vertigo, cyclic vomiting syndrome, cannabinoid hyperemesis syndrome, eating disorder, meds

CMP including mag/phos, u/a, CBC, coag

RUQUS if elevated LFTs

2018 ACOG guidelines on nausea/vomiting in pregnancy: 

   -1g ginger daily if not on anticoag

   -acupressure wristband

   -small, frequent meals with low fat, high carbs

-10-25mg vit B6 q8

-doxylamine

-metoclopramide, ondansetron (potential increased risk of congenital heart disease if <10 weeks), promethazine overall safe in pregnancy

If risk of refeeding syndrome, 100mg thiamine followed by dextrose containing IVF

#heartburn, nausea, vomiting during pregnancy

-ACG 2022 monograph

#constipation, hemorrhoids, and anorectal disorders during pregnancy

-ACG 2022 monograph

-constipation in 25-40%; treat with senna, PEG,

-hemorrhoids and anal fissure in 2/3 women during pregnancy; hydration, fiber, treatment of constipation, topical ointment

if thrombosed hemorrhoids and extremely painful, incise and decompress

#fecal incontinence and diarrhea