Critical Care Obstetrics

Critical Care Obstetrics

Improve medical outcomes for both mothers and children with this essential guide

For the first time in decades, maternal mortality rates are climbing in the United States. Factors including lack of access to prenatal care, un- or underinsured populations, rising rates of cardiovascular disease, and more combine to make pregnancy and childbirth more dangerous prospects. In this environment, the study of critical care obstetrics has never been more essential.

Critical Care Obstetrics, Seventh Edition a fully updated guide to the medical management of serious conditions in pregnancy and childbirth. Beginning with basic principles, it surveys the potential serious complications occurring in pregnancy and delivery and the techniques and procedures for maximizing patient outcomes for both pregnant people and fetuses. This clear, accessible text promises to continue the essential work of earlier editions.

Readers of the seventh edition of Critical Care Obstetrics will also find:

Detailed protocols for implementing life-saving treatments in emergencies

New chapters on topics including ECMO, antibiotics, and pneumonia

Authorship by internationally renowned experts in emergency obstetrics

Critical Care Obstetrics is ideal for working clinical obstetricians and for trainees in obstetrics and gynecology.

 

 

Table of Contents:

 

Part One: Basic Critical Care Clinical and Surgical Principles

1 Epidemiology of Critical Illness in Pregnancy

Introduction

Pregnancy‐related hospitalizations

Maternal mortality

Perinatal mortality

Pregnancy‐related ICU admissions

Summary

Acknowledgments

References

2 Organizing an Obstetrical Critical Care Unit: Care without Walls

Background

Critical care for obstetric patients

Unit design: ICU without walls

Patient population

Members of the team

Guidelines, bundles, development, and education

Summary

References

3 Critical Care Obstetric Nursing

Introduction

Standards of nursing care

Critical care technology: critical concepts and application to clinical practice

Interpretation of hemodynamic and oxygen transport data

Levels of maternal care

Care environment

Nursing education and training

Nurse‐led bedside rounds

Nursing practice guidelines, policies, procedures, and care bundles

References

4 Pregnancy‐Induced Physiologic Alterations

Cardiovascular system

Respiratory system

Genitourinary system

Gastrointestinal system

Hematologic system

Endocrine system

Immune system

Conclusion

References

5 Maternal Blood Gas Physiology

Introduction

Essential physiology

Oxygen delivery and consumption

Respiratory components of the arterial blood gas

Disorders of acid–base balance

Conclusion

References

6 Fluid and Electrolyte Balance

Introduction

Fluid resuscitation

Isotonic crystalloid solutions

Colloid solutions

Sodium disorders

Hypernatremia

Potassium disorders

Hypokalemia

Calcium disorders

Hypocalcemia

Hypercalcemia

Magnesium disorders

References

7 Interventional Radiology in Pregnancy

Introduction

Indication and timing of interventional procedures

Intraprocedural sedation

Intraprocedural imaging guidance and radiation dose reduction

Interventions for venous access

Interventions for venous thromboembolism

Interventions for visceral artery aneurysms

Interventions for vascular malformations

Interventions in the urinary tract

Interventions in the biliary tract

Interventions for postpartum hemorrhage

Interventions for postpartum hemorrhage in settings of abnormal placentation

Interventions post‐cesarean section

Complications of interventional procedures

Conclusion

Key points

Acknowledgments

References

8 Fetal Considerations in the Critically Ill Gravida

Introduction

Detection of fetal distress in the critically ill obstetric patient

Periodic changes or FHR changes in response to uterine contractions

Overview of periodic changes

Two important “FHR” patterns

FHR patterns in the brain‐damaged infant

Fetal monitoring in the ICU made simple

Maternal and surgical conditions

Perimortem cesarean delivery

References

Goals of therapy

Critical laboratory tests

Consultation

Perimortem cesarean

9 Fetal Effects of Drugs Commonly Used in Critical Care

Introduction

Maternal analgesia and sedation

Cardiovascular drugs

Other cardiovascular drugs

Thrombolytic therapy

Endocrine emergencies

Mannitol

Resource

Conclusion

Key points

References

10 Maternal–Fetal Oxygenation

Maternal adaptations favoring fetal oxygenation

Placental factors to enhance fetal oxygenation

Placental transfer of oxygen and carbon dioxide

Fetal adaptations favoring fetal oxygenation

Fetal oxygenation survival with a low PO2

Maternal oxygen therapy in obstetrics and maternal hyperoxygenation (MHO)

Oxygen therapy for acute fetal distress

Oxygen therapy for the fetus with IUGR

Oxygen therapy in cases of congenital heart disease

Oxygen therapy for fetal distress due to maternal hypoxia

Conclusion

References

11 Cardiopulmonary Resuscitation (CPR) in Pregnancy

Introduction

Epidemiology

Etiology

Management

Aortocaval compression

Medications

Extracorporeal membranous oxygenation (ECMO) and extracorporeal life support (ECLS)

Post‐arrest care

Summary

References

12 Neonatal Resuscitation in the Critical Care Setting

Introduction

Elements of birth depression

Elements of a resuscitation

Preparation for a resuscitation

Initial steps and evaluation

Medications

Immediate care after establishing adequate ventilation and circulation

Special problems during resuscitation

Screening for congenital anomalies

Conclusion

References

13 Ventilator Management in Critical Illness

Introduction

Respiratory failure

Oxygen delivery and consumption

Assessing oxygenation

Therapy

Ventilator modes

Alternative maneuvers during mechanical ventilation

Weaning from mechanical ventilation

Respiratory system interactions

Conclusion

References

14 Vascular Access

Introduction

Preparing for catheter insertion

Complications – general

Specific venous access sites

Specific arterial access sites

Catheter‐related infection

Conclusion

Acknowledgment

References

15 Nutritional Support

Introduction

Normal nutrition in pregnancy

Malnutrition in pregnancy

Nutritional assessment during pregnancy

Weight gain during pregnancy

Routes for nutritional support

Calculation of nutritional requirements

Amino acids

Carbohydrates

Fat emulsions

Fluid and electrolytes

Monitoring and complications

References

16 Acute Kidney Injury and Renal Replacement Therapy

Definition of acute renal failure

Changes of renal function in pregnancy

Management: general principles

Renal replacement therapy

Summary

References

17 Cardiopulmonary Bypass

Introduction

Maternal and fetal risks of cardiopulmonary bypass

Alternatives to CPB

Surgical timing and concurrent cesarean section

Mechanics of cardiopulmonary bypass

Physiology of CPB

Management of cardiopulmonary bypass

Summary

References

18 ECMO in Obstetrics

Introduction

VV‐ECMO

Principles of VV‐ECMO and pregnancy considerations

Mechanical ventilation and gas exchange targets

Hemodynamic targets

Lung rest strategies

Fetal consideration during ECMO

Timing of delivery

Maternal and neonatal outcomes on ECMO

Principles of venoarterial ECMO

Anticoagulation during ECMO (VV and VA)

Complications of ECMO (VV and VA)

VA‐ECMO in pregnancy

Conclusions

References

19 Antibiotics, Antivirals, and Antifungals in Critical Care

Introduction

Pharmacokinetics and pharmacodynamics of antimicrobials

Pharmacokinetics

Drug distribution

Drug metabolism and clearance

Drug elimination

Pharmacodynamics

Mechanism of antibiotic action

Antibiotics resistance

Antibiotic treatment in critically ill pregnant patients

Biomarkers to initiate antibiotics

Antimicrobial choice

Methicillin‐resistant Staphylococcus aureus (MRSA)

Multidrug‐resistant bacteria

Antibiotics dosing

Continuous prolonged or intermittent administration of time‐dependent antibiotics

Duration of antibiotic therapy

Pharmacokinetics and pharmacodynamics of antivirals

Pharmacokinetics, drug absorption, drug metabolism, and clearance

Antiviral use and treatment in critically ill pregnant patients

Fungal therapy

Pharmacokinetics and pharmacodynamics of antifungals: azoles and echinocandins

Antifungal treatment in critically ill pregnant patients

Diagnosis of antifungal infections

Treatment and duration

References

20 Noninvasive Monitoring in Critical Care

Introduction

Approach to monitoring

Role in diagnosis and therapy

Evidence and implementation

Physiology of monitoring

Oxygen consumption, oxygen delivery, and cardiac output

The Frank–Starling mechanism in clinical practice

Routine noninvasive monitoring

Measurement of oxygenation

Invasive assessment of arterial oxygenation

Assessing ventilation and evaluating for acidemia

Assessment of blood pressure

Ascertaining cardiac output

End‐organ monitoring in critical illness

Noninvasive monitoring and the fetus

Point‐of‐care ultrasound for maternal indications

Assessment of cardiac function

Assessment of fluid responsiveness

A dynamic approach to noninvasive hemodynamic monitoring

References

21 Critical Care Drills in Obstetrics

Obstetric emergencies

Location

Teamwork and behaviors

Communication

Simulators

Education

Frequency and skill retention

Outcomes

In situ testing of new facilities

Scenarios

Debriefing

Conclusions

Resources

Disclaimer

References

Appendix: In Situ Critical Care Simulation Example

22 Maternal–Fetal Transport in the High‐Risk Pregnancy

Introduction

Epidemiology of maternal mortality

Role and rationale for regionalization of maternal care

Transport program components

Condition‐specific considerations for common transport indications

Opportunities to improve the system of risk‐based care

References

Part Two: Acute Emergencies

23 Seizure and Status Epilepticus

Introduction

Etiology

Seizure prophylaxis

Evaluation of new‐onset seizures in pregnancy

Treatment of seizures

Status epilepticus

Subsequent management and prognosis

Key points

References

24 Acute Spinal Cord Injury

Introduction

Maternal primary survey and specific considerations due to SCI

Circulation

Other early management concerns

Additional medical SCI complications

Rehabilitation

Summary

References

25 Severe Acute Asthma

Introduction

Maternal and fetal physiologic considerations during pregnancy

Interrelationship between asthma and pregnancy

Assessment of asthma during pregnancy

Management of asthma during pregnancy

Management of acute asthma during pregnancy

Management of asthma during labor and delivery

Obstetric management of the pregnant asthmatic patient

Summary

References

26 Acute Respiratory Distress Syndrome in Pregnancy

Introduction

Definition

Epidemiology

Pathophysiology and etiology

Clinical features

Management

Summary

References

27 The Acute Abdomen During Pregnancy

Introduction

Physiologic changes

Differential diagnosis

Diagnostic imaging

Laparoscopy during pregnancy

Appendicitis during pregnancy

Cholecystitis during pregnancy

Bowel obstruction during pregnancy

Adnexal torsion during pregnancy

Bariatric surgery and acute abdomen in pregnancy

Summary

References

28 Acute Pancreatitis

Introduction

Pathology and pathophysiology

Etiology

Diagnosis

Natural history and complications

Clinical predictors of severity

Management

Conclusion

References

29 Pneumonia During Pregnancy (Bacterial and Viral)

Introduction

Respiratory changes in pregnancy

Pneumonia diagnosis

Assessment of severity

Identification of causative agent

Bacterial pneumonia treatment

Viral pneumonias

References

30 Acute Fatty Liver of Pregnancy

Introduction

Epidemiology

Pathogenesis

Clinical presentation

Diagnosis

Treatment

Supportive care

Summary

References

31 Disseminated Intravascular Coagulation

Introduction

Pathophysiology

Diagnosis of DIC

Scoring for DIC

Use of viscoelastic assays

Management of obstetrical DIC

Conclusion

References

32 Endocrine Emergencies

Introduction

Diabetic ketoacidosis

Thyroid disorders

Adrenal dysfunction

References

33 Acute Psychiatric Conditions in Pregnancy: Critical Care Obstetrics

Introduction

Acute depression and anxiety

Suicide and suicidality

Acute mania and psychosis

Substance use disorder in pregnancy

Birth trauma and postpartum posttraumatic stress

Ethical considerations

Conclusion

References

34 Diabetic Ketoacidosis

Normal regulation of ketogenesis

Diabetic ketoacidosis

Pregnancy predisposes to the development of ketoacidosis

Evaluation

Effective serum osmolality

Corrected sodium

The anion gap

Diagnosis

Measurement of ketones

Treatment

Monitoring the response to treatment

Resolution

Prevention of DKA

Summary

References

Part Three: Shock in Pregnancy

35 Hypovolemic Shock

Introduction

Impact of obstetric hemorrhage

Causes of obstetric hemorrhage

Hypovolemic shock

Identifying hypovolemic shock

Management of hypovolemic shock in pregnancy

Oxygenation

Pharmacologic agents

Initial volume replacement

Blood safety

Blood product transfusion

Massive transfusion protocols

Monitoring volume status during hypovolemic shock and resuscitation

Further evaluation

Hemostasis

Key points

References

36 Blood Component Therapy and Massive Transfusion

Introduction

Blood donation, collection, and storage

Blood components: description and indications

Transfusion practices

Obstetric hemorrhage

Massive transfusion

Patients with bleeding or hematological diathesis

Autologous blood

Transfusion reactions

Concluding comments

References

37 Etiology and Management of Hemorrhage (Includes Accreta)

Placental abruption

Uterine rupture

Placenta accreta spectrum (PAS)

Primary postpartum hemorrhage

Uterine inversion

Treatment of uterine atony

Surgical management of postpartum hemorrhage

Bleeding disorders

Conclusion

Key points

References

38 Septic Shock

Introduction

Screening tools for sepsis and septic shock

Pathophysiology of septic shock

Clinical presentation of septic shock

Predisposing factors in obstetrics

Pregnancy and septic shock

Diagnosis of septic shock in pregnancy

Treatment of septic shock

Other supportive therapies

Alternative treatment modalities

References

39 Cardiogenic Shock

Introduction

Pathogenesis

Acute myocardial infarction

Peripartum cardiomyopathy

Mitral stenosis

Aortic stenosis

Arrhythmias

Aortic dissection

Pulmonary hypertension

Cardiogenic shock due to right heart failure

Summary

References

40 Anaphylactic Shock in Pregnancy

Introduction

Nomenclature

Epidemiology

Pathophysiology

Diagnosis

Precipitants

Treatment of anaphylaxis

Management of the patient after the acute episode of anaphylaxis

Conclusions

References

41 Amniotic Fluid Embolism

Introduction

Historic considerations

Experimental models

Clinical presentation

Differential diagnosis of amniotic fluid embolism

Diagnosis

International criteria for diagnosis of amniotic fluid embolism

Treatment

Recurrence risks of AFE In Subsequent Pregnancies

Conclusions

References

Part Four: Medical/Surgical Management

42 Pregnancy‐Related Stroke

Introduction

Definitions

Classification of stroke

Pregnancy physiology and pathophysiology that influence stroke risk

Risk factors and conditions predisposing to PRS

Presenting symptoms

General evaluation, assessment, and management of stroke

General management of stroke in pregnancy

Intracranial hemorrhagic strokes

Ischemic stroke

Special pregnancy considerations

Pregnancy‐related risks of stroke

Key points for stroke care and management during pregnancy

References

43 Cardiac Disease and Pregnancy

Introduction

Counseling the pregnant cardiac patient

Physiologic considerations

Congenital cardiac lesions

Pulmonary hypertension and Eisenmenger syndrome

Ebstein anomaly

Coarctation of the aorta

Tetralogy of Fallot

Transposition of the great vessels

Pulmonic stenosis

Aortic stenosis

Functional single ventricle and Fontan procedure

Fetal considerations

Acquired cardiac lesions

Peripartum cardiomyopathy

Hypertrophic cardiomyopathy

Marfan syndrome

Myocardial infarction

Spontaneous coronary artery dissection

Anticoagulation and prosthetic heart valves

Prevention of infective endocarditis

Maternal arrhythmias

Pregnancy after cardiac transplantation

References

44 Anesthesia Considerations for the Critically Ill Gravida with Cardiac Disease

Introduction and epidemiology

Cardiopulmonary changes in pregnancy

Congenital heart disease

Acquired heart disease

Anticoagulation therapy in a parturient

Ischemic heart disease

Pulmonary hypertension

Peripartum cardiomyopathy

Heat transplantation

Cardiovascular surgery during pregnancy

Summary

References

45 Thromboembolic Disease

Incidence and risk factors

Normal hemostasis

Thrombophilias

Pulmonary embolus

Antepartum management

Intrapartum management

Postpartum management

Prophylaxis of thromboembolism

References

46 Pulmonary Hypertension in Pregnancy

Introduction

Pulmonary hypertension – definition and classification

WHO clinical classification groups of pulmonary hypertension

Clinical features of pulmonary hypertension

Diagnosis of pulmonary hypertension in pregnancy

Cardiopulmonary changes during pregnancy, labor, and postpartum

Fluid management

CTEPH

Termination

Summary

References

Appendix 46.1: Management of Pulmonary Hypertension during Pregnancy

47 Sickle Cell Disease and Pregnancy

Introduction

Epidemiology

Pathophysiology

Clinical features

Maternal and fetal outcomes in SCD

Preconception considerations

Antepartum care

Complications

Acute chest syndrome

Stroke

Delivery

Postpartum care

Infant care

Contraception

Conclusion

References

48 Thrombotic Thrombocytopenic Purpura, Hemolytic–Uremic Syndrome, and HELLP

Thrombotic thrombocytopenic purpura (TTP)

Clinical features

Laboratory findings

Pathophysiology of TTP

Treatment of TTP

Investigational treatments

TTP during pregnancy

Differential diagnosis

Hemolytic–uremic syndrome

HELLP syndrome

Key points

References

49 Complications of Preeclampsia

Introduction

Etiology of preeclampsia

Clinical definitions and diagnosis of preeclampsia

General management principles for preeclampsia

Cardiopulmonary complications of preeclampsia

Renal complications with preeclampsia

HELLP syndrome

Liver and gastrointestinal complications of preeclampsia

Neurologic complications with preeclampsia

Uteroplacental–fetal complications of preeclampsia

Conclusions

References

50 Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Introduction

Systemic lupus erythematosus in pregnancy

Obstetric complications in women with SLE

Neonatal lupus erythematosus

Diagnosis of SLE and detection of SLE exacerbation (flare)

Medications used for SLE during pregnancy

Treatment of SLE flare during pregnancy

Breastfeeding

Antiphospholipid syndrome in pregnancy

References

51 Trauma in Pregnancy

Introduction

Maternal physiologic adaptations applicable to trauma during pregnancy

Management of trauma

The fetal patient

Manifestations of trauma during pregnancy

Conclusion

References

52 Thermal and Electrical Injury

Introduction

Classification

Maternal concerns

Management strategies

Maternal complications

Fetal complications

Conclusions

Key points

References

53 Overdose, Poisoning, and Envenomation during Pregnancy

Definitions

Scope of the problem

Toxicologic considerations in pregnancy

Evaluation of the poisoned pregnant patient

Toxic identification

Decontamination procedures

Acetaminophen

Amphetamines

Antidepressants

Aspirin

Barbiturates

Benzodiazepines

Carbon monoxide

Cocaine [133–135,139–156]

Ethanol [157–175]

Iron* [176–183]

Organophosphates (and carbamates) [184–213]

Envenomations during pregnancy [214–262]

Maternal critical illness and the opioid epidemic

Summary

References

54 The Organ Transplant Patient in the Obstetric Critical Care Setting

Background

Prepregnancy evaluation

Prenatal care

Immunosuppression during pregnancy

Renal transplant

Pancreas or pancreas/kidney transplant

Liver transplantation

Heart transplant

Lung transplant

Bone marrow transplant

Uterine transplant

Special circumstances

References

55 Fetal Surgery Procedures and Associated Maternal Complications

Introduction

Open fetal surgery

Closed surgical therapies

Maternal complications

Summary

References

56 Cancer in the Pregnant Patient

Introduction

Surgical principles during pregnancy

Cervical dysplasia and cancer

Management of adnexal masses occurring in pregnancy

Ovarian cancer

Other gynecologic malignancies in pregnancy

Non‐gynecological cancers in pregnancy

Conclusion

Key points

References

57 Mass Casualties and the Obstetrical Patient

Domestic events

International events

References

58 Biological, Chemical, and Radiological Exposures in Pregnancy

Introduction

Background

Summary

References

Part Five: Ethical and Legal Considerations

59 Ethics in the Obstetric Critical Care Setting

Introduction

Ethical principles

Informed consent

Competency

Status of the fetus

Practical applications of ethical principles to high‐risk obstetrics

Conclusion

References

60 Medical–Legal Considerations in Critical Care Obstetrics

Negligence and causation

Foreseeability of harm

The standard of care for the specialist and nonspecialist

The duty to refer the patient to a specialist [12]

Standard of care for nurses [13]

Critical conduct intervals [2]

Informed consent [16]

The prevailing standards for patient informed consent

What must be disclosed?

Informed consent is not necessary

Informed refusal [34,35]

General guidelines for informed consent

The duty to warn [36]

Hypothetical cases

Discussion

References

Index

End User License Agreement

 

An aparitie	25 apr 2024
Autor	Luis D. Pacheco, Jeffrey P. Phelan, Torre L. Halscott, Leslie A. Moroz, Arthur J. Vaught, Antonio F. Saad, Amir A. Shamshirsaz
Editura	Wiley
Format	Hardcover
ISBN	9781119820239
Limba	Engleza
Nr pag	1216