Critical care in obstetrics

Abstract

Pregnancy is a normal physiologic process with the potential for pathologic states. Pregnancy has several unique characteristics including an utero-placental interface, a physiologic stress that can cause pathologic states to develop, and a maternal–foetal interface that can affect two lives simultaneously or in isolation. Critical illness in pregnant women may result from deteriorating preexisting conditions, diseases that are co-incidental to pregnancy, or pregnancy-specific conditions. Successful maternal and neonatal outcomes for parturients admitted to a maternal critical care facility are largely dependent on a multidisciplinary input to medical or surgical condition from critical care physicians, obstetric anaesthesiologists, obstetricians, obstetric physicians, foetal medicine specialists, neonatologists, and concerned specialists. Pregnant women requiring maternal critical care unit admission are relatively low in developed nations and range from 0.9% to 1%; but in our country, the admission rates of critically ill parturients range from 3% to 8%. Two-thirds of pregnant women requiring critical care are often unanticipated at the time of conception. In this review, we will look at critical illnesses in pregnant women with a specific focus on pregnancy-induced illnesses.

Obstetric anaesthesia as a career

“…From a clinical perspective, obstetric anaesthesia is a busy speciality; further it offers the potential to practise across a wide spectrum of medical disciplines – obstetrics, neonatology, maternal-foetal medicine, critical care, surgery while continuing the perioperative anaesthesia practice. [ 7 8 9 10 11 12 ] The Mallampati grades change rapidly in the mother and demand diligent clinical, airway, regional anaesthetic and pain management skills. [ 13 ] Maternal comorbidity like anaemia, hypertensive crises, diabetes and cardiovascular diseases can affect maternal wellbeing in the short and long term.…”

Correlation between response time and infant outcome in pregnant women with fetal distress undergoing caesarean section in two tertiary hospitals

“…The babies were born at 34-37 weeks of gestation. 4 As many as 66% of fetal distress cases occurred in mothers with hypertension and 12% in mothers with total placenta previa accompanied by bleeding. Apart from hypertension, total placenta previa, especially those with active flux, often results in fetal distress incidence.…”

“…In total placenta praevia totalis that is accompanied by bleeding, there is acute insufficiency of utero-placental flow which may lead to fetal distress. 4 The most common type of anesthesia was general anesthesia which was performed in 65 patients (63%) compared to regional anesthesia in 38 patients (37%). Of the two types of anesthesia, general anesthesia is the main choice of anesthesia in cesarean section of pregnant women with fetal distress because general anesthesia does not require a long time to start the incision when compared to regional anesthesia.…”

The correlation of nutritional status with hematology toxicity of adjuvant chemotherapy in ovarian cancer

“…In total placenta praevia totalis that is accompanied by bleeding, there is acute insufficiency of utero-placental flow which may lead to fetal distress. 4 The most common type of anesthesia was general anesthesia which was performed in 65 patients (63%) compared to regional anesthesia in 38 patients (37%).…”