{"id":9585,"date":"2014-03-12T17:24:51","date_gmt":"2014-03-12T21:24:51","guid":{"rendered":"https:\/\/crashingpatient.com\/?p=9585"},"modified":"2014-03-12T17:24:51","modified_gmt":"2014-03-12T21:24:51","slug":"obstetric-critical-care-management","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/ob-gyn\/obstetric-critical-care-management.htm\/","title":{"rendered":"Obstetric Critical Care Management"},"content":{"rendered":"

<\/span>Review Article (J Intensive Care Med.<\/a> 2006 Sep-Oct;21(5):278-86)<\/span><\/h3>\n

<\/span>Vent Stuff<\/span><\/h2>\n

\u2191 alveolar ventilation (20-40%), \u2191 TV, \u2191 RR<\/p>\n

Compensated hypocarbia (Normal 25-32 and normal bicarb 18-21)<\/p>\n

Mechanical ventilation- need to adjust for PaCO2 30-32 (compensated hypercarbia); no studies show harm with permissive hypercarbia<\/p>\n

Faster desaturation: \u2191 O2 consumption + \u2193 function residual capacity + \u2191 small airway collapse with exhalation<\/p>\n

<\/span>Meds<\/span><\/h2>\n

Avoid benzos and NSAIDs<\/p>\n

First line should be norepi for pressors<\/p>\n

<\/span>Placenta<\/span><\/h2>\n

No auto-regulation of the blood supply, fetal distress may = mom compensated shock<\/p>\n

<\/span>Fetal Monitoring<\/span><\/h2>\n

<\/span>Uterine Activity<\/span><\/h3>\n

consider monitoring after 20 weeks<\/p>\n

<\/span>Fetal Heart Rate Monitoring<\/span><\/h3>\n

consider after 24 weeks<\/p>\n

mom in full lateral tilt, IV fluids, supp. ox<\/p>\n

<\/span>Hematological changes<\/span><\/h2>\n

\u2191 RBC mass (20%)<\/p>\n

\u2191 Plasma volume (40-50%)<\/p>\n

<\/span>Sepsis<\/span><\/h2>\n

pyelo more common<\/p>\n

chorioamnionitis<\/p>\n

endometritis<\/p>\n

ScvO2 not accurate<\/p>\n

Critical Care<\/p>\n

 <\/p>\n

 <\/p>\n

Sedation- avoid benzos and NSAIDS; limited data exists for Propofol or Precedex<\/p>\n

Vasopressors- #1 is NE!<\/p>\n

Fetal monitoring-<\/p>\n

Look for uterine contractility- eval for abruption or premature labor >20 weeks<\/p>\n

Start fetal HR monitoring EARLY, is an early warning for maternal distress<\/p>\n

Sepsis- UTI\/Pyelo are common; post-partum: Endometritis<\/p>\n

Maternal trauma- even minor trauma can cause fetal harm, recommend:<\/p>\n

4 hrs min of Fetal HR monitoring, longer with: 1) contraction, bleeding, abdominal pain<\/p>\n

Steroids early for surfactant formation<\/p>\n

Image mom as NEEDED (don\u2019t hold back if its is important)<\/p>\n

Put in chest tubes HIGHER than expected<\/p>\n

Fetomaternal hemmorhage: 30% of trauma patients<\/p>\n

Quant: Kleinhauer-Betke testing (fetal cells in circulation<\/p>\n

Give Rho-Gam early<\/p>\n

 <\/p>\n

Pregnancy Specific Problems:<\/p>\n

 <\/p>\n

Pre-eclampsia\/Eclampsia:<\/p>\n

Features: HTN, Hypovolemia, Renal dysfunction<\/p>\n

40% of Eclampsia is post-partum<\/p>\n

Tx: HTN meds, MgSO4 (watch for AKI)<\/p>\n

HELLP:<\/p>\n

15% w\/o HTN or proteinuria<\/p>\n

Features: plts<100, hemolytic anemia, LFT dysfunction, and RUQ pain<\/p>\n

Tx all SBP>160 or DBP>110 = \u2193 CVA risk<\/p>\n

Acute fatty liver of pregnancy:<\/p>\n

Features: similar to HELLP but with more significant liver failure<\/p>\n

Tx: delivery (though some need transplant)<\/p>\n

Amniotic fluid embolism:<\/p>\n

Normally immediately following labor (w\/in 8 mins)<\/p>\n

SIRS + anaphylaxis \u2192 severe hypoxemia<\/p>\n

20-40% mortality (with severe neurological morbidity)<\/p>\n

DIC is a staple of the disease<\/p>\n

Cardiomyopathy:<\/p>\n

Peripartum (up to 5 months)<\/p>\n

LVEF <30%<\/p>\n

\u2191 to trop\/BNP = worse outcome<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Review Article (J Intensive Care Med. 2006 Sep-Oct;21(5):278-86) Vent Stuff \u2191 alveolar ventilation (20-40%), \u2191 TV, \u2191 RR Compensated hypocarbia (Normal 25-32 and normal bicarb 18-21) Mechanical ventilation- need to adjust for PaCO2 30-32 (compensated hypercarbia); no studies show harm with permissive hypercarbia Faster desaturation: \u2191 O2 consumption + \u2193 function residual capacity + \u2191 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[18,12],"tags":[],"yoast_head":"\nObstetric Critical Care Management - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/ob-gyn\/obstetric-critical-care-management.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/ob-gyn\/obstetric-critical-care-management.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/ob-gyn\/obstetric-critical-care-management.htm\/\",\"name\":\"Obstetric Critical Care Management - 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