Chronic Medical Disorders Quick-Reference (asthma · epilepsy · cardiac · CKD · SLE/APS)
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
Triage and handover guidance for a multi-condition index. This is not a complete asthma, epilepsy, cardiac, renal or autoimmune discharge protocol; the relevant specialty plan must be attached.
When admission or continued hospital care is needed
- Severe breathlessness/hypoxia, chest pain/syncope, prolonged/recurrent seizure, acute kidney injury/oliguria, severe hypertension or systemic autoimmune/obstetric deterioration requires urgent hospital assessment and appropriate admission.
When clinic, day care or home care may be suitable
- A stable chronic diagnosis alone does not mandate admission. A named respiratory, neurological, cardiac, renal or rheumatology plan is required for the actual condition.
Before going home
- The acute problem is resolved and the relevant specialty has agreed treatment, monitoring and the safe care setting.
- Persistent organ dysfunction, oxygen/infusion requirements or an unexplained seizure must not be covered by a generic discharge checklist.
Discharge medicines and treatment changes
- Reconcile each disease-specific medicine, pregnancy/postpartum changes, renal dosing and breastfeeding safety. Do not abruptly stop essential anti-seizure, cardiac or steroid treatment without a specialist plan.
Tests, pending results and their reviewer
- Document the actual disease/organ results, pending investigations and named specialty reviewer; test schedules depend on that diagnosis.
Home care and counselling
- Give an illness-specific action plan, medication access and clear emergency contacts.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before leaving | Book the actual specialty/maternity follow-up and tests for the diagnosed condition. |
After birth or a major medicine change | Arrange early reassessment rather than assuming the prepregnancy regimen remains suitable. |
Return urgently
- Breathlessness, chest pain, collapse, seizure, severe headache, reduced urine or rapid deterioration needs urgent hospital care.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
Domain-specific emergencies follow their modules; this page is a continuity checklist.
③ First-line treatment & drug regimens
- Booking: medication reconciliation against TERATOGEN list; specialist letters obtained
- Trimester checkpoints: disease activity labs + organ function
- Birth planning: unit capability matched to mWHO/CKD stage/SLE activity
- Postpartum: flare windows (SLE), medication continuation, lactation compatibility table applied
Monitoring
- Individualised per condition above
Escalation
- Joint clinics (obstetric-medicine) strongly recommended
⑮ Complications & their management
Flare vs PE confusion
Complement levels, anti-dsDNA, proteinuria trend differentiate
Post-treatment care
- 6-week specialist review each condition
Principles & follow-up
Special situations
| Condition | Pregnancy-critical points |
|---|---|
Asthma | ICS safe & essential - undertreatment kills; LABA continue; montelukast OK; acute attack treated FULLY (O2+SABA+steroids); fetal hypoxia is the danger |
Epilepsy | NEVER abrupt-stop ASM; lamotrigine/levetiracetam favoured (levels fall - increase doses!); valproate avoid where possible; folic acid 5 mg/day; single-drug lowest-effective principle |
Cardiac disease | mWHO classification drives unit level; NYHA reviews each trimester; endocarditis prophylaxis per lesion policy; anticoagulation switches managed by cardiology; watch heart-failure window 28-34 wks + postpartum |
CKD | Stage-linked risks; BP target <140/90 with labetalol/nifedipine; aspirin; nephrology co-care; ACEi/ARB stopped pre-conception (enalapril OK postpartum/lactation) |
SLE | Plan conception in quiet disease (hydroxychloroquine CONTINUE - protective); azathioprine/calcineurin-inhibitors compatible; mycophenolate/cyclophosphamide STOP; neonatal lupus (anti-Ro) surveillance; flares vs PE differentiation |
APS | Obstetric APS: aspirin + prophylactic LMWH from positive test; thrombotic APS: therapeutic LMWH; platelet watch |
Sources (6)
2016; updates 2020–2025 (2nd ed maternal-health compendium 2025-03) · checked 2026-08-23 · verified-live
Open source ↗
WHO pages + NCBI compendium: daily IFA 30–60 mg elemental iron + 400 µg folic acid; intermittent IFA only where daily not acceptable & anaemia prevalence <20%; anaemia in ANC → 120 mg elemental iron daily until Hb normal; MMS recommended only within rigorous research contexts (supersedes 2016); ≥8 c…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…