Critical illness in specific populations
Critical illness in pregnancy
General approach to the pregnant or postpartum patient
Critical illness and pregnancy
Clinical review: Special populations - critical illness and pregnancy
Patrick J Neligan et al., Critical Care (2011)
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.
Specific diseases in pregnancy
Cardiovascular diseases
Cardiovascular diseases during pregnancy
2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC)
Vera Regitz-Zagrosek et al., European Heart Journal (2018)
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.
Liver diseases
Liver diseases in pregnancy
EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy
Catherine Williamson et al., Journal of Hepatology (2023)
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.
Trauma
Trauma in pregnancy
Practice Management Guidelines for the Diagnosis and Management of Injury in the Pregnant Patient: The EAST Practice Management Guidelines Work Group
Robert D. Barraco et al., Journal of Trauma: Injury, Infection & Critical Care (2010)
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.
Cardiac arrest in the obstetric patient
Cardiac arrest in pregnancy
European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances
Carsten Lott et al., Resuscitation (2021)
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