Management of the critically ill obstetric patient


      From 2006 to 2008, 261 women in the United Kingdom died either as a direct or indirect result of pregnancy. More than half of these received critical care input. The support required varied from observation and supportive management to multi-organ support. In many women death occurred despite optimal care, but in a number substandard care was identified when the cases were reviewed as part of the Confidential Enquiry into Maternal Deaths. An understanding of the different types of organ support and treatment that are available in a critical care setting and when these are indicated is therefore crucial for medical professionals caring for these unwell obstetric patients.
      Described here are the technical aspects of organ support that can be utilized in a critical care setting and the alterations in physiology that occur in pregnancy which influence the use of each treatment modality. Also highlighted in more detail are conditions that are common or life threatening in pregnancy and key points about management of these conditions when they mandate critical care support.


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      Further reading

      1. Bersten A. Soni N. Oh's intensive care manual. 6th edn. Butterworth-Heinemann, 2008
        • Bone R.
        • Balk R.
        • Cerra F.
        • et al.
        Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.
        Chest. 1992; 101: 1644-1655
        • Centre for Maternal and Child Enquiries (CMACE)
        Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.
        BJOG. 2011; 118: 1-203
      2. Critical care in obstetrics.
        Best Pract Res Clin Obstet Gynaecol. 2008; 22: 761-996
      3. Female admissions (aged 16–50 years) to adult, general critical care units in England Wales and Northern Ireland, reported as ‘currently pregnant’ or ‘recently pregnant’. 1 January 2007–31 December 2007 ICNARC, 2009. .

        • Royal College of Obstetricians and Gynaecologists
        Bacterial sepsis in pregnancy. Green-top guideline No. 64a.
        RCOG, London2012
        • West J.B.
        Pulmonary pathophysiology: the essentials.
        7th edn. Lippincott Williams & Wilkins, 2008
        • Westbrook R.H.
        • Yeoman A.D.
        • Joshi D.
        • et al.
        Outcomes of severe pregnancy-related liver disease: refining the role of transplantation.
        Am J Transplant. 2010; 10: 2520-2526