Critical care obstetrics for the obstetrician and gynecologist:
Saved in:
| Other Authors: | |
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| Format: | Book |
| Language: | English |
| Published: |
Philadelphia, Pennsylvania
Elsevier
[2016]
|
| Series: | Obstetrics and gynecology clinics of North America
volume 43, number 4 (December 2016) |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | xvi Seiten, Seite 611-854 Illustrationen |
| ISBN: | 9780323477451 |
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| 245 | 1 | 0 | |a Critical care obstetrics for the obstetrician and gynecologist |c editors Carolyn M. Zelop, Stephanie R. Martin |
| 264 | 1 | |a Philadelphia, Pennsylvania |b Elsevier |c [2016] | |
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| adam_text | Titel: Critical care obstetrics for the obstetrician and gynecologist
Autor: Zelop, Carolyn M
Jahr: 2016
Critical Care Obstetrics for the Obstetrician and Gynecologist
Contents
Foreword: An End to Happiness...Attention to the Critically III Parturient xiii
William F. Rayburn
Preface: Contemporary Obstetric Intensive Care xv
Carolyn M. Zelop and Stephanie R. Martin
Critical Care for the Obstetrician and Gynecologist: Obstetric Hemorrhage and
Disseminated Intravascular Coagulopathy 611
Arthur Jason Vaught
Obstetric hemorrhage accounts for 5% of all deliveries in the United States
and accounts for high maternal morbidity and mortality. Many hemor-
rhages are secondary to uterine atony and are quickly ameliorated with
appropriate uterotonic use. However, for a subset of cases, severe hem-
orrhage may require advanced resuscitative techniques, and innovative
procedural and surgical techniques. This article guides a provider through
such a resuscitation.
Management of Hypertensive Crisis for the Obstetrician/Gynecologist 623
Jamil EIFarra, Cynthia Bean, and James N. Martin Jr
Hypertensive disorders of pregnancy are among the leading preventable
contributors of maternal and fetal adverse outcomes, including maternal
and fetal death. Blood pressure increase has a strong association with un-
favorable pregnancy outcomes, including stroke and pulmonary edema. A
persistent blood pressure measurement greater than or equal to 160/110
mm Hg lasting for more than 15 minutes, during pregnancy or postpartum,
is considered an obstetric emergency and requires rapid appropriate treat-
ment. Following evidence-based guidelines, implementing institutional po-
lices, and understanding the classification and pathophysiology of
hypertensive disorders of pregnancy are essential and can significantly
improve the rate of preventable complications.
Management of Infection for the Obstetrician/Gynecologist 639
Catherine Eppes
Pregnant women have an increased morbidity and mortality for certain ill-
nesses owing to the physiologic and immunologic changes in pregnancy.
Certain infections are common during pregnancy, including urinary tract
infections and pneumonia. Others are uncommon, but yield increased
severity, including influenza. Human immunodeficiency virus, although it
does not increase in pathogenesis during pregnancy, requires specific
attention and management in the context of pregnancy.
viii Contents
Management of Sepsis and Septic Shock for the Obstetrician-Gynecologist 659
Lauren A. Plante
The incidence of sepsis is increasing in the United States, both in the gen-
eral adult population and among pregnant and postpartum women. Neither
infection nor bacteremia are synonymous with sepsis: it is a dysregulated
host response to a pathogen in which organ dysfunction is key. New clinical
criteria have been released. Cornerstones of management are early suspi-
cion and recognition, effective fluid resuscitation, and appropriate antimi-
crobial therapy.
Immune Regulation in Pregnancy: A Matter of Perspective? 679
Elizabeth A. Bonney
The maternal immune system is complex and governed by multiple hor-
monal and metabolic factors, including those provided to the mother via
the fetus. Understanding of the balance between maternal tolerance and
protection of the fetus may require thinking from multiple theoretical ap-
proaches to the general problem of immune activation and tolerance.
This article provides a brief review of the immune system, with aspects
relevant to pregnancy. The references include reviews that expand on
the elements discussed. The article also uses different models of immune
system activation and tolerance to provide a theoretical understanding of
the problem of maternal tolerance.
Respiratory Considerations Including Airway and Ventilation Issues in Critical
Care Obstetric Patients 699
Holly Ende and Dirk Varelmann
Critical care management of the obstetric patient can present unique
challenges. Parturients who present with respiratory distress can suffer
from a multitude of etiologies, and each diagnosis must be pursued as
appropriate to the clinical picture. Normal physiologic changes of preg-
nancy may obscure the presentation and diagnosis, and irrelevant of
the cause, pregnancy may complicate the management of hypoxic and
hypercarbic respiratory failure in this patient population. In addition to
these concerns, both anticipated and unanticipated difficult airway man-
agement, including difficulty ventilating and intubating, are more common
during pregnancy and may be encountered during endotracheal tube
placement.
Cardiac Lesions in the Critical Care Setting 709
Manisha Gandhi and Amir A. Shamshirsaz
The long-held belief that pregnancy is absolutely contraindicated in
maternal cardiovascular disease is no longer justifiable using evidence-
base medicine. There are some conditions in which pregnancy is contra-
indicated, and high maternal risk and poor fetal outcome can be predicted.
However, in many women with heart disease, a more favorable maternal
and fetal outcome is expected. This article focusses on the cardiac condi-
tions that require more attention and have the potential to require observa-
tion in the intensive care unit setting.
Contents ix
Evaluation and Management of Maternal Cardiac Arrhythmias 729
Torri D. Metz and Amber Khanna
Pregnant women often complain of palpitations. The differential diagnosis
for new-onset palpitations in pregnancy ranges from benign conditions to
life-threatening arrhythmias. Maternal arrhythmias can occur in isolation or
in the setting of underlying structural heart disease. Optimal management
of maternal cardiac arrhythmias includes identification of the specific
arrhythmia, diagnosis of comorbid conditions, and appropriate interven-
tion. In general, management of maternal cardiac arrhythmias is similar
to that of the general population. Special consideration must be given
as to the effects of medications and procedures on both the mother and
fetus to optimize outcomes. The importance of multidisciplinary care
with cardiology, obstetrics, and anesthesia is emphasized.
Management of Acute Kidney Injury in Pregnancy for the Obstetrician 747
Anjali Acharya
Acute kidney injury (AKI) is a complex disorder that occurs in several clin-
ical settings. During pregnancy, there are additional unique conditions that
contribute to AKI. The clinical manifestations of AKI during pregnancy
range from a minimal elevation in serum creatinine to renal failure requiring
renal replacement therapy, similar to AKI in the general population. Recent
epidemiologic studies in the general population show an increase in mor-
tality associated with AKI, particularly when dialysis is required. The inci-
dence of AKI in pregnancy remains a cause of significant morbidity and
mortality.
Obesity and the Critical Care Pregnant Patient 767
Garrett K. Lam
The rise of obesity among gravid women has been tracked and docu-
mented in many first-world countries, but a dramatic rise has been noted
over the last 15 years. Definitions of normal-weight, overweight and
obese have been defined; however, new terms are used to describe
more severe degrees of obesity. Obesity in any form or degree increases
morbidities in mothers. The unique physiologic characteristics of the
obese gravida set up unique challenges in her management, especially
in an acute setting such as labor. The definitions, trends, and management
decisions pertaining to the obese parturient will be described in this
review.
Amniotic Fluid Embolism 779
Amir A. Shamshirsaz and Steven L. Clark
Amniotic fluid embolism remains one of the most devastating conditions in
obstetric practice with an incidence of approximately 1 in 40,000 deliveries
and a reported mortality rate ranging from 20% to 60%. The pathophysi-
ology involves an abnormal maternal response to fetal tissue exposure
associated with breaches of the maternal-fetal physiologic barrier during
parturition. This response and its subsequent injury involve activation of
proinflammatory mediators similar to that seen with the classic systemic
x Contents
inflammatory response syndrome. Maternal treatment is primarily support-
ive, whereas prompt delivery in the mother who has sustained cardiopul-
monary arrest is critical for improved newborn outcome.
Trauma and Considerations Unique to Pregnancy 791
Christy Pearce and Stephanie R. Martin
Trauma complicates 6% to 7% of all pregnancies and requires multidisci-
plinary education and training for both trauma and obstetric teams to
achieve the best outcome. It is important to understand the mechanisms
of certain adverse maternal and fetal/neonatal outcomes incurred as a
result of trauma, as well as caveats to pregnancy physiology that make
some injuries more likely and detection of maternal compromise more diffi-
cult. This article focuses on these caveats and how to incorporate these
into ongoing trauma protocols and offers suggestions for the formation
of obstetric trauma response teams.
Cardiac Arrest and Resuscitation Unique to Pregnancy 809
Terri-Ann Bennett, Vern L. Katz, and Carolyn M. Zelop
Maternal cardiopulmonary arrest (MCPA) is a catastrophic event that can
cause significant morbidity and mortality. A prepared, multidisciplinary
team is necessary to perform basic and advanced cardiac life support spe-
cific to the anatomic and physiologic changes of pregnancy. MCPA is a
challenging clinical scenario for any provider. Overall, it is an infrequent
occurrence that involves 2 patients. However, key clinical intervention per-
formed concurrently can save the life of both mother and baby.
Obstetric Transport 821
Julie Scott
Obstetric transport is a specialized medical transport for maternal, fetal,
and neonatal concerns. Perinatal regionalization of care provides a
broader geographic availability of obstetric services with defined levels
of maternal and neonatal care so that women can be transported to cen-
ters with increased resources and capabilities to reduce morbidity and
mortality. The Emergency Medical Treatment and Active Labor Act pro-
vides regulatory guidance for care of laboring women who require transfer
to a higher level of care. The Situation, Background, Assessment, and
Recommendation communication can identify key pieces of medical infor-
mation with recommendations given for mutual expectations of next steps.
Index
841
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| spelling | Critical care obstetrics for the obstetrician and gynecologist editors Carolyn M. Zelop, Stephanie R. Martin Philadelphia, Pennsylvania Elsevier [2016] xvi Seiten, Seite 611-854 Illustrationen txt rdacontent n rdamedia nc rdacarrier Obstetrics and gynecology clinics of North America volume 43, number 4 (December 2016) Clinics review articles Zelop, Carolyn M. (DE-588)1123090416 edt Obstetrics and gynecology clinics of North America volume 43, number 4 (December 2016) (DE-604)BV000617486 43,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=029422691&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Critical care obstetrics for the obstetrician and gynecologist Obstetrics and gynecology clinics of North America |
| title | Critical care obstetrics for the obstetrician and gynecologist |
| title_auth | Critical care obstetrics for the obstetrician and gynecologist |
| title_exact_search | Critical care obstetrics for the obstetrician and gynecologist |
| title_full | Critical care obstetrics for the obstetrician and gynecologist editors Carolyn M. Zelop, Stephanie R. Martin |
| title_fullStr | Critical care obstetrics for the obstetrician and gynecologist editors Carolyn M. Zelop, Stephanie R. Martin |
| title_full_unstemmed | Critical care obstetrics for the obstetrician and gynecologist editors Carolyn M. Zelop, Stephanie R. Martin |
| title_short | Critical care obstetrics for the obstetrician and gynecologist |
| title_sort | critical care obstetrics for the obstetrician and gynecologist |
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