{"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":"
\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
Avoid benzos and NSAIDs<\/p>\n
First line should be norepi for pressors<\/p>\n
No auto-regulation of the blood supply, fetal distress may = mom compensated shock<\/p>\n
consider monitoring after 20 weeks<\/p>\n
consider after 24 weeks<\/p>\n
mom in full lateral tilt, IV fluids, supp. ox<\/p>\n
\u2191 RBC mass (20%)<\/p>\n
\u2191 Plasma volume (40-50%)<\/p>\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":"\n