Enda Stress Dose Hc Labor

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name: enda-stress-dose-hc-labor
description: Recommends hydrocortisone stress dosing during the active phase of labor for pregnant patients with primary adrenal insufficiency, using a regimen similar to major surgical stress. Trigger phrases: "active phase of labor", "cervix dilation ≥4 cm", "contractions every 5 minutes", "PAI patient in labor".
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# Administer Hydrocortisone Stress Dosing During Active Phase of Labor

## STEP 1 — Gather Information
Confirm diagnosis of primary adrenal insufficiency (PAI) in pregnant patient; assess labor status: active phase defined as cervix dilation ≥4 cm and/or regular contractions every 5 minutes for the last hour; obtain intravenous access; review allergies and contraindications.

## STEP 2 — Rule In / Rule Out
Rule in if pregnant PAI patient is in active phase of labor (cervix ≥4 cm and/or contractions q5min). Rule out if not in active labor, patient lacks confirmed PAI, or has known hypersensitivity to hydrocortisone.

## STEP 3 — Classify or Stratify
Proceed to stress dosing regimen; no further stratification needed as all active labor PAI patients receive same stress dose.

## STEP 4 — Decide
Administer hydrocortisone 100 mg IV bolus followed by continuous infusion of 200 mg/24 hours (or equivalent) until delivery; after delivery, taper rapidly to prepregnancy maintenance dose.

## Clinical Guardrails / Mimics / Pitfalls
Do not use dexamethasone (not inactivated by placenta); avoid delaying stress dosing until after delivery; monitor for signs of fluid overload or infection; ensure patient has steroid emergency card; consider mineralocorticoid replacement if hypotension persists despite glucocorticoid stress dosing.

## Concrete Clinical Example
A 32-year-old woman with known PAI at 39 weeks gestation presents with regular contractions every 4 minutes and cervix 5 cm dilated. She receives hydrocortisone 100 mg IV bolus, then infusion 200 mg/24 hrs. After vaginal delivery 2 hours later, infusion is stopped and she resumes her usual oral hydrocortisone 20 mg daily.

**Source:** Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710