CRITICAL CARE OBSTETRICS SRI SATHYA SAI INSTITUTE …危重病妇产科赛巴巴所….pptVIP

Organizing a Critical Care Obstetric Unit WHEN TO INTERVENE : CONSULT!!! Prevalence of obstetric pts in ICU 100-900 per 100,000 gestations Maternal mortality :55-920 per 100,000 gestations in developing countries Critical illnesses in pregnancy and 6 weeks’ postpartum Obstetric hemorrhage Placental abruption/Placenta previa Preeclampsia, Eclampsia HELLP syndrome Chorioamnionitis/Puerperal sepsis Acute fatty liver of pregnancy Amniotic fluid embolism Pelvic thrombophlebitis Peri partum cardiomyopathy Critical illnesses in pregnancy and 6 weeks’ postpartum Infections Falciparum Malaria Viral Hepatitis E Varicella pneumonia H1N1 Infection Renal – acute renal failure Hematologic DIC; Venous thrombosis Endocrine : DM, sheehan’s syndrome Neurologic – intra cranial hemorrhage (ICH) Respiratory -Pulmonary embolism - Venous air mbolism - Mendelson syndrome C. Conditions unrelated to pregnancy Trauma, Burns Diabetic ketoacidosis Cytomegalovirus infection HIV Community acquired pneumonia ARDS Bronchial asthma Drug abuse Cardiovascular Valvular disease Eisenmenger’s syndrome cyanotic congenital heart disease coarctation of aorta Primary pulmonary hypertension Renal: - Glomerulonephritis, -Chronic renal insufficiency Hematologic - sickle cell disease, anemia Liver - Cirrhosis Endocrine, Diabetes mellitus, prolactinoma Reumatologic:Scleroderma, polymyositis Respiratory: cystic fibrosis, lung transplant Neurologic Epilepsy Intracranial tumors Masthenia gravis multiple sclerosis. Account for 20-50% of admissions to ICU Respiratory: Airway Management in Critical Illness key points in airway intubation of pregnant women Fetal well-being depends on maternal well-being Assess airway even in urgent intubations Avoid aspiration: elevate head of bed, cricoid pressure, sod citrate, smaller ETT in size Need of Lower dose of sedatives/anesthetics Pre-oxygenation Respiratory: Airway Management in Critical Illness ↑