Hill Amanda, Neuberger Francesca
Department of Medicine, Gloucester Royal Hospital, Gloucester, UK.
Department of Women's and Children's, Southmead Hospital, North Bristol Trust, Bristol, UK.
Clin Med (Lond). 2025 Jan;25(1):100273. doi: 10.1016/j.clinme.2024.100273. Epub 2024 Dec 3.
If a woman is acutely confused in pregnancy, she will most likely present to an unscheduled care setting outside of maternity services. It is therefore essential that all clinicians working within general medicine are comfortable assessing pregnant women in this context. Useful resources are available to support assessing pregnant women who present acutely; however, confusion is beyond their scope. This article discusses important aspects to consider when assessing pregnant women and places emphasis on a systematic approach to ensure that obstetric and non-obstetric causes of confusion have been considered. Certain life-threatening diagnoses have been further discussed in more detail (Wernicke's encephalopathy, hyponatraemia, hypercalcaemia, acute fatty liver of pregnancy and thrombotic thrombocytopenia purpura). These conditions have been chosen as there is a significant risk of maternal mortality and morbidity as well as poor fetal outcomes if not recognised and treated early.
如果一名女性在孕期出现急性意识混乱，她很可能会前往产科服务以外的非预约护理机构就诊。因此，所有从事普通内科工作的临床医生必须能够在这种情况下对孕妇进行评估。现有一些有用的资源可支持对急性就诊的孕妇进行评估；然而，意识混乱超出了这些资源的范畴。本文讨论了评估孕妇时需要考虑的重要方面，并强调采用系统方法以确保已考虑到导致意识混乱的产科和非产科原因。某些危及生命的诊断已作更详细的讨论（韦尼克脑病、低钠血症、高钙血症、妊娠急性脂肪肝和血栓性血小板减少性紫癜）。选择这些病症是因为如果不及早识别和治疗，孕产妇发生死亡和发病的风险以及胎儿预后不良的风险都很高。
