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Chapter 5. Pregnancy and Critical Illness

Mary E Strek, MD, FCCP
DOI: 10.1378/critcare.21.5
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Sections

Objectives 
  • Review normal maternal physiologic adaptations to pregnancy.

  • Understand oxygen delivery to and the effects of critical illness on the fetus.

  • Recognize and treat acute cardiovascular disorders and shock in pregnancy.

  • Diagnose and manage acute pulmonary disease and causes of acute hypoxemic respiratory failure in pregnancy.

  • Review pregnancy-specific disorders such as preeclampsia, amniotic fluid embolism and acute fatty liver.

Synopsis 

Critical illness in pregnancy can be a devastating occurrence. The physiologic changes of pregnancy may both mask and worsen the underlying critical illness, and all interventions must take into account the well-being of the fetus as well as the mother. While it is fortunate that critical illness in pregnancy is infrequent, most intensivists will have little experience to draw on when caring for these patients. This chapter will review the physiologic changes of pregnancy with an emphasis on those organ systems most affected by critical illness. Cardiac disorders will be reviewed with a focus on the diagnosis and treatment of hypoperfused states such as cardiogenic, hemorrhagic, and septic shock. Preeclampsia, a disease characterized by widespread vascular endothelial dysfunction, has a variable presentation, as it affects many organ systems. For optimal maternal and fetal outcomes, early diagnosis and treatment of preeclampsia is essential. Pulmonary disorders such as acute asthma exacerbations and venous thromboembolism are more common in pregnancy and have guidelines to direct management. In some cases, critical illness results from a worsening of underlying disease or the onset of a pregnancy related illness. In all cases, understanding the physiologic changes of pregnancy, knowledge of the most advanced approach to diagnosis and treatment, and inclusion of the obstetric team in care will result in the optimal outcome for both mother and fetus.

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