Skip to main content
SpringerLink
Log in

Intensive Care in Obstetrics

  • Chapter
  • First Online:
Principles of Adult Surgical Critical Care

  • 2186 Accesses

Abstract

Intensive care admissions comprise a small percentage of the obstetric population; however, it is becoming increasingly necessary to decrease maternal mortality in this group. Pregnancy is a unique stage in a woman’s life and has a significant impact on the mother’s physiology, making the management of these patients challenging and different from the nonpregnant population. In this chapter, we will discuss the impact of intensive care management in pregnant and postpartum patients as well as the physiologic changes and pathology unique to gravid patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Zwart JJ, Dupuis JR, Richters A, et al. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive Care Med. 2010;36:256.

    PubMed  Google Scholar 

  2. Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med. 2010;36:1465.

    PubMed  Google Scholar 

  3. Zeeman G. Obstetric critical care: a blueprint for improved outcomes. Crit Care Med. 2006;34(9 suppl):S208.

    PubMed  Google Scholar 

  4. Hoyert DL. Maternal mortality and related concepts. National Center for Health Statistics. Vital Health Stat. 2007;3(33):4.

    Google Scholar 

  5. Creanga, et al. Pregnancy-related mortality in the United States. Obstet Gynecol. 2015;125:5.

    PubMed  Google Scholar 

  6. Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol. 2012;36:2.

    PubMed  Google Scholar 

  7. Souza JP, et al. The WHO maternal near-miss approach and the Maternal Severity Index Model (MSI): tools for assessing the management of severe maternal morbidity. PLoS One. 2012;7(8):e44129. doi:10.1371/journal.pone.0044129.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Crobman, et al. Frequency of and factors associated with severe maternal morbidity. Obstet Gynecol. 2014;123(4):804–10.

    Google Scholar 

  9. Lemeshow S, Teres D, Klar J, et al. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270:2478–86.

    CAS  PubMed  Google Scholar 

  10. Carle, et al. Design and internal validation of an obstetric early warning score. Anaesthesia. 2013;68:354–67.

    CAS  PubMed  Google Scholar 

  11. Clapp J, Capeless E. Cardiovascular function before, during and after the first and subsequent pregnancies. Am J Cardiol. 1997;80:1469.

    PubMed  Google Scholar 

  12. Clark S, Cotton D, Lee W, et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol. 1989;161:1439.

    CAS  PubMed  Google Scholar 

  13. Granger J. Maternal and fetal adaptations during pregnancy and integrative physiology. Am J Physiol Regul Integr Comp Physiol. 2002;283:R1289.

    CAS  PubMed  Google Scholar 

  14. Bhagwat A, Engel P. Heart disease and pregnancy. Cardiol Clin. 1995;13:163.

    CAS  PubMed  Google Scholar 

  15. Thornburg KL, Jacobson SL, Giraud GD, Morton MJ. Hemodynamic changes in pregnancy. Semin Perinatol. 2000;24(1):11–4.

    CAS  PubMed  Google Scholar 

  16. Goodwin AP, Pearce AJ. The human wedge: a manoeuvre to relieve aortocaval compression during resuscitation in late pregnancy. Anaesthesia. 1992;47:433.

    CAS  PubMed  Google Scholar 

  17. Jones SJ, Kinsella SM, Donald FA. Comparison of measured and estimated angles of table tilt at Caesarean section. Br J Anaesth. 2003;90:86–7.

    CAS  PubMed  Google Scholar 

  18. Kundra P, Khanna S, Habeebullah S, Ravishankar M. Manual displacement of the uterus during Caesarean section. Anaesthesia. 2007;62:460–5.

    CAS  PubMed  Google Scholar 

  19. Robson S, Dunlop W, Boys R, et al. Cardiac output during labour. BMJ. 1987;295:1169.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Kerr M. Cardiovascular dynamics in pregnancy and labour. Br Med Bull. 1968;24:19.

    Google Scholar 

  21. Polanczyk C, Rohde L, Goldman L, Cook E, Thomas E, Marcantonio E, et al. Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study. JAMA. 2001;286:309–14.

    CAS  PubMed  Google Scholar 

  22. Invasive hemodynamic monitoring in obstetrics and gynecology. ACOG Technical Bulletin Number 175–December 1992. Int J Gynaecol Obstet. 1993; 42:199–205.

    Google Scholar 

  23. Crapo R. Normal cardiopulmonary physiology during pregnancy. Clin Obstet Gynecol. 1996;39:3.

    CAS  PubMed  Google Scholar 

  24. Schatz M, Zieger R. Diagnosis and management of rhinitis during pregnancy. Allergy Proc. 1988;9:545.

    CAS  PubMed  Google Scholar 

  25. Motoyama E, Rivard G, Acheson F, Cook C. Adverse effect of maternal hyperventilation on the fetus. Lancet. 1966;1:286–8.

    CAS  PubMed  Google Scholar 

  26. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA. 1990;263:2753.

    Google Scholar 

  27. Pritchard J. Changes in blood volume during pregnancy and delivery. Anesthesiology. 1965;26:393.

    CAS  PubMed  Google Scholar 

  28. Lo F, Kaufman S. Effect of 5α-pregnan-3α-ol-20-one on nitric oxide biosynthesis and plasma volume in rats. Am J Physiol Regul Integr Comput Physiol. 2000.

    Google Scholar 

  29. Pitkin R, Witte D. Platelet and leukocyte counts in pregnancy. JAMA. 1979;242:2696.

    CAS  PubMed  Google Scholar 

  30. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120:689.

    PubMed  Google Scholar 

  31. Albright CM, Ali TN, Lopes V, et al. The sepsis in obstetrics score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. 2014;211:39.

    Google Scholar 

  32. Lockitch G. Clinical biochemistry of pregnancy. Crit Rev Clin Lab Sci. 1997;34:67.

    CAS  PubMed  Google Scholar 

  33. Present P, Comstock GW. Tuberculin sensitivity in pregnancy. Am Rev Respir Dis. 1975;112:413.

    CAS  PubMed  Google Scholar 

  34. Lindheimer M, Davison J, Katz A. The kidney and hypertension in pregnancy: twenty exciting years. Semin Nephrol. 2001;21:173.

    CAS  PubMed  Google Scholar 

  35. Dunlop W. Serial changes in renal haemodynamics during normal pregnancy. Br J Obstet Gynaecol. 1981;88:1.

    CAS  PubMed  Google Scholar 

  36. Ezimokhai M, Davison J, Philips P, et al. Non-postural serial changes in renal function during the third trimester of normal human pregnancy. Br J Obstet Gynaecol. 1981;88:465.

    CAS  PubMed  Google Scholar 

  37. Yeomans E, Gilstrap L. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med. 2005;33(10 Suppl):S256–8.

    PubMed  Google Scholar 

  38. Sorensen and on behalf of the Cardiac Disease in Pregnancy (CARPREG) Investigators, Gordon P, Spears JC, Tam JW, Amankwah KS, Smallhorn JF, Farine D, Morton S, Kells CM, Bergin ML, Kiess MC, Marcotte F, Taylor DA, Siu ESC, Sermer M, Colman JM, Alvarez AN, Mercier L-A, Brian C. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515–21.

    Google Scholar 

  39. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy.Obstet Gynecol. 2013;122(5):1122–31.

    Google Scholar 

  40. LaMarca BD, Gilbert J, Ganger JP. Recent progress toward the understanding of the pathophysiology of hypertension during preeclampsia. Hypertension. 2008.

    Google Scholar 

  41. Zhou CC, Zhang Y, Irani RA. Angiotensin receptor agonistic autoantibodies induce pre-eclampsia in pregnant mice. Nat Med. 2008;14:855–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. LaMarca BD, Ryan MJ, Gilbert JS, Murphy SR, Granger JP. Inflammatory cytokines in the pathophysiology of hypertension during preeclampsia. Curr Hypertens Rep. 2007;9(6):480–5.

    CAS  PubMed  Google Scholar 

  43. Pritchard JA, Baldwin RM, Dickey JC, et al. Blood volume changes in pregnancy and the puerperium. II. Red blood cell loss and changes in apparent blood volume during and following vaginal delivery, cesarean section, and cesarean section plus total hysterectomy. Am J Obstet Gynecol. 1962;84:1271.

    Google Scholar 

  44. Dildy GA. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. 2002;45:330.

    PubMed  Google Scholar 

  45. Elbourne DR, Prendiville WJ, Carroli G, et al. Prophylactic use of oxytocin in the third stage of labour. Cochrane Database Syst Rev. 2001.

    Google Scholar 

  46. Prata N, Gerdts C. Measurement of postpartum blood loss. BMJ. 2010;340:c555.

    PubMed  Google Scholar 

  47. Novello A, King JC. Health advisory: prevention of maternal deaths through improved management of hemorrhage. www.acog.org/acog_districts/dist_notice.cfm?recno=1&bulletin=1517. Accessed 2 May 2006.

  48. Bakri YN, Amri A, Abdul Jabber F. Tamponade-balloon for obstetrical bleeding. Int J Gynecol Obstet. 2001;74:139.

    CAS  Google Scholar 

  49. B-Lynch C, Coker A, Lawal AH, et al. The B-Lynch surgical technique for control of massive postpartum haemorrhage: an alternative to hysterectomy? Five cases reported. Br J Obstet Gynaecol. 1997;104:275.

    Google Scholar 

  50. Cho JH, Jun HS, Lee CN. Hemostatic suturing technique for uterine bleeding during cesarean delivery. Obstet Gynecol. 2000;96:129.

    CAS  PubMed  Google Scholar 

  51. Clark SL. Amniotic fluid embolism. Clin Obstet Gynecol. 2010;53:322.

    PubMed  Google Scholar 

  52. Oxford C, Ludmir J. Trauma in pregnancy. Clin Obstet Gynecol. 2009;52(4):611–29.

    PubMed  Google Scholar 

  53. Mäkikallio K, McElhinney DB, Levine JC, et al. Fetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for fetal intervention. Circulation. 2006;113(11):1401–5.

    Google Scholar 

  54. Mattox KL, Goetzl L. Trauma in pregnancy. Crit Care Med. 2005;33:385–9.

    Google Scholar 

  55. Dijkman A, Huisman CM, Smit M, et al. Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? BJOG. 2010;117:282.

    CAS  PubMed  Google Scholar 

  56. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S829.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, 19107, USA

    Corrina Oxford MD & Mauricio La Rosa MD

Authors
  1. Corrina Oxford MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauricio La Rosa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corrina Oxford MD .

Editor information

Editors and Affiliations

  1. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Niels D. Martin

  2. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lewis J. Kaplan

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Oxford, C., La Rosa, M. (2016). Intensive Care in Obstetrics. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_36

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33341-0_36

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33339-7

  • Online ISBN: 978-3-319-33341-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation