No abstract

Pulmonary embolism is the leading cause of maternal death in the United States. Amniotic fluid embolism (AFE) represents the least preventable and most lethal of complications with a reported mortality of 86% and an associated fetal demise of 50%. Although it is widely accepted as a clinical entity, AFE is incompletely understood. A combination of clinical presentation, laboratory findings, and exclusion of other pathologies leads to the diagnosis of AFE. The mainstays of treatment are oxygenation, maintenance of cardiac output, and correction of coagulopathy. The prognosis for the patient experiencing AFE remains bleak because it is largely unpredictable and, except for supportive measures, cannot be corrected.

A better understanding of why women die during pregnancy, childbirth, or postpartum offers valuable insight into strategies aimed at preventing maternal deaths and arresting the progression in the severity of a complication. The rate of severe maternal morbidity and maternal mortality in the United States has been trending upward in recent years and has garnered national attention with concentration on bolstering reviews of maternal deaths and implementing patient safety initiatives. The obstetric nurse is in a unique position to improve maternal outcomes through the anticipation, recognition, and communication of the early warning signs of impending deterioration in maternal condition. Presented in the context of the conceptual model of Stephen Covey's Circle of Influence, the professional nurse can proactively influence maternal outcomes directly, with actions defined by the scope of professional nursing practice or indirectly through professional interactions with others. Advancing one's education, knowledge, and technical skills broadens the influential capacity.

Critical care obstetrics is gaining increased recognition as a subspecialty of perinatal medicine. As the specialty continues to expand, many institutions may consider establishing a critical care obstetric service. However, implementing such a service is not feasible for every institution because of space limitations, budgetary constraints, lack of necessary resources, and/or a limited number of critically ill obstetric patients. This article explores strategies for examining the feasibility of establishing a critical care obstetric service, suggests methods of implementation, and offers an alternative when establishing a critical care obstetric service is not feasible.

Complications of pregnancy-induced hypertension (PIH) remain a leading cause of maternal mortality in the United States. The etiology of the disease is not fully understood, but pathologic effects of PIH on maternal organ systems are well documented. Present strategies for management emphasize prevention and control of eclamptic seizure and hypertensive crisis and correction of fluid imbalance. The article reviews current trends in drug therapy for the acute management of PIH. Topics discussed include evaluation of magnesium sulfate as an anticonvulsant, hydralazine versus labetalol for management of hypertension, and the role of colloid osmotic pressure in fluid therapy.