Critical illness in pregnancy

What’s inside

This article reviews critical illness during pregnancy, focusing on pregnancy-specific conditions that require intensive care. It discusses the physiological changes in pregnancy, the management of critically ill pregnant patients, and the impact of critical illness on both maternal and fetal outcomes.

Why it’s relevant

Critical illness during pregnancy is rare but can be life-threatening. Understanding the unique challenges and management strategies is crucial for improving maternal and fetal outcomes in intensive care settings.

Key focus

• Pregnancy-specific critical illnesses:
  • Obstetric hemorrhage
  • Pre-eclampsia and eclampsia
  • HELLP syndrome
  • Acute fatty liver of pregnancy
  • Amniotic fluid embolus syndrome
  • Peripartum cardiomyopathy
• Management strategies:
  • Coordinated multidisciplinary care
  • Adjustments to therapeutic targets due to pregnancy-related physiological changes
  • Importance of fetal monitoring and timely delivery
• Complications:
  • Sepsis
  • Cardiac arrest
  • Brain death

Takeaway

Effective management of critically ill pregnant patients requires a multidisciplinary approach, with adjustments to standard critical care practices to account for the physiological changes of pregnancy. Timely intervention and delivery can significantly improve outcomes for both the mother and the fetus.

What’s inside

The 2018 ESC guidelines provide evidence-based recommendations for the management of cardiovascular diseases during pregnancy, focusing on diagnosis, treatment, and risk stratification.

Why it’s relevant

Cardiovascular diseases during pregnancy pose significant risks to both mother and fetus, requiring specialized care to optimize outcomes.

Key focus

• Risk assessment and preconception counseling for women with cardiovascular diseases
• Management of specific conditions (e.g., hypertension, valvular heart disease)
• Monitoring and treatment strategies during pregnancy and postpartum
• Delivery planning and anesthetic considerations

Takeaway

The guidelines emphasize a multidisciplinary approach, integrating risk assessment, tailored treatment, and close monitoring to ensure safe pregnancies for women with cardiovascular diseases.

What’s inside

This article provides the EASL clinical practice guidelines for the management of liver diseases in pregnancy, focusing on diagnosis, treatment, and maternal-fetal outcomes.

Why it’s relevant

Liver diseases in pregnancy can lead to severe complications for both mother and fetus, requiring specialized care to optimize outcomes.

Key focus

• Diagnosis and management of pregnancy-specific liver diseases (e.g., intrahepatic cholestasis of pregnancy, HELLP syndrome)
• Management of pre-existing liver diseases during pregnancy
• Monitoring and treatment strategies to reduce maternal and fetal risks
• Postpartum care and long-term follow-up

Takeaway

The guidelines emphasize early diagnosis, multidisciplinary care, and tailored treatment to ensure safe pregnancies and improve outcomes for women with liver diseases.

What’s inside

This article provides practice management guidelines for the diagnosis and management of trauma in pregnant patients, focusing on maternal and fetal outcomes.

Why it’s relevant

Trauma during pregnancy poses unique challenges, requiring specialized care to ensure the safety of both mother and fetus.

Key focus

• Initial assessment and resuscitation of pregnant trauma patients
• Diagnostic imaging and radiation safety considerations
• Management of specific injuries and complications (e.g., placental abruption)
• Monitoring and delivery planning in trauma cases

Takeaway

The guidelines emphasize a multidisciplinary approach, integrating trauma care with obstetric expertise to optimize outcomes for pregnant patients and their fetuses.

What’s inside

The ERC Guidelines 2025 on Special Circumstances in Resuscitation provide evidence-based recommendations for managing cardiac arrest in obstetric patients. The guidelines emphasize the importance of recognizing pregnancy-specific causes of cardiac arrest, such as pre-eclampsia, puerperal sepsis, and placental complications, and highlight the need for immediate interventions like manual left uterine displacement and resuscitative hysterotomy.

Why it’s relevant

Cardiac arrest in pregnancy is a rare but critical event with unique challenges due to physiological changes and potential fetal involvement. These guidelines are essential for healthcare professionals to optimize maternal and fetal outcomes by addressing reversible causes and ensuring timely, specialized interventions.

Key focus

• Recognize pregnancy in any collapsed woman of childbearing age
• Relieve aortocaval compression with manual left uterine displacement
• Prepare for immediate resuscitative hysterotomy if ROSC is not achieved
• Address pregnancy-specific reversible causes (4Ps: pre-eclampsia, puerperal sepsis, placental/uterine issues, peripartum cardiomyopathy)
• Use standard ALS protocols with modifications for airway management and defibrillation

What’s inside

This review addresses the critical role of perimortem cesarean delivery (PMCD) in trauma settings, emphasizing its life-saving potential for both mother and fetus. It outlines the physiological changes during pregnancy, the urgency of PMCD, and practical steps for trauma clinicians, especially in resource-limited areas.

Why it’s relevant

PMCD is a rare but vital intervention in maternal cardiac arrest, where rapid action can significantly improve survival outcomes. This review equips trauma clinicians with essential knowledge and techniques, ensuring readiness to act decisively in emergencies where obstetric expertise may be unavailable.

Key focus

• Physiological changes in pregnancy affecting resuscitation
• Indications and timing for PMCD in maternal cardiac arrest
• Step-by-step technique for performing PMCD
• Importance of multidisciplinary training and preparation
• Challenges and considerations in rural or resource-poor settings