Maternal-Fetal Assessment of the Critically Ill Parturient: Decisions Related to Delivery

Abstract

Preparation for delivery of the critically ill pregnant women begins soon after admission to the intensive care unit. Unless maternal or fetal condition deteriorates, remaining in utero may be more beneficial to the premature fetus. A decision regarding the timing of delivery is based on the impact on maternal and fetal well-being of maintaining the fetus in utero. Maternal or fetal instability may necessitate immediate delivery, and specialist from critical care, obstetrics, neonatology, and anesthesiology should decide on the most appropriate location for labor and delivery. Personnel from affected departments are alerted as soon as possible to facilitate the gathering of necessary equipment and supplies and the attendance of skilled professionals in intrapartum management and neonatal resuscitation.

Acute respiratory distress syndrome in pregnancy

“…Shortly after beginning care for a pregnant woman with ARDS, fetal assessment should take place and plans for possible delivery should be made (89). These plans are influenced by the gestational age of the fetus, fetal status, maternal status, and the gestational age at which the treating institution can support a preterm infant, which is often 24 -26 wks for larger centers.…”

“…Electronic fetal monitoring consists of assessing fetal heart rate and uterine activity over a period of time (89). Electronic fetal monitoring consists of assessing fetal heart rate and uterine activity over a period of time (89).…”

“…Electronic fetal monitoring consists of assessing fetal heart rate and uterine activity over a period of time (89). Fetal heart rate variability does not occur until approximately 28 wks of gestation, and a variety of other maternal-fetal factors can result in a non-reassuring pattern without fetal compromise being present (89,91). Fetal heart rate variability does not occur until approximately 28 wks of gestation, and a variety of other maternal-fetal factors can result in a non-reassuring pattern without fetal compromise being present (89,91).…”

“…Fetal biophysical profile (BPP) scoring is based on the theory that fetal asphyxia will elicit consistent, protective fetal responses that can be monitored by ultrasound, including changes in breathing movements, tone, limb movements, and heart rate variability (89). Fetal biophysical profile (BPP) scoring is based on the theory that fetal asphyxia will elicit consistent, protective fetal responses that can be monitored by ultrasound, including changes in breathing movements, tone, limb movements, and heart rate variability (89).…”

“…Fetal biophysical profile (BPP) scoring is based on the theory that fetal asphyxia will elicit consistent, protective fetal responses that can be monitored by ultrasound, including changes in breathing movements, tone, limb movements, and heart rate variability (89). Fetal growth, which gives additional information about the chronic fetal condition, can also be assessed during the BPP ultrasound (89). BPP scoring thus provides an assessment of both the acute fetal state, with relatively precise correlation between the BPP score and fetal pH, and the chronic fetal condition (92).…”