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Pre-eclampsia diagnosis and management. Best Pract Res Clin Anaesthesiol 2022; 36:107-121. [DOI: 10.1016/j.bpa.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
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Martínez-Rodríguez JE, Camacho-Yacumal A, Unigarro-Benavides LV, Nazareno DY, Fernández-Pabón J, Burbano-Imbachí A, Cardona-Gómez DC, Cedeño-Burbano AA. Anestesia para pacientes con preeclampsia. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n1.65756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La preeclampsia es una enfermedad con alta frecuencia a nivel mundial relacionada con la gestación. Las pacientes que la padecen pueden precisar un procedimiento anestésico por diversos motivos, incluidas las complicaciones graves.Objetivo. Realizar una revisión narrativa de la literatura respecto a las pautas principales del tratamiento anestésico de pacientes con preeclampsia.Materiales y métodos. Se realizó una búsqueda estructurada en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos Anesthesia AND pre-eclampsia AND therapeutics; hypertension, Pregnancy-Induced AND anesthesia AND therapeutics; anesthesia AND pre-eclampsia; hypertension, pregnancy induced AND anesthesia. La búsqueda se hizo en inglés con sus equivalentes en español.Resultados. Se encontraron 61 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. Una valoración preanestésica y la instauración temprana de las técnicas analgésicas y anestésicas pueden mitigar el impacto de complicaciones derivadas del curso de la preeclampsia. Respecto a desenlaces mayores, no existe diferencia significativa entre los distintos tipos de anestesia.
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Cornette J, Laker S, Jeffery B, Lombaard H, Alberts A, Rizopoulos D, Roos-Hesselink JW, Pattinson RC. Validation of maternal cardiac output assessed by transthoracic echocardiography against pulmonary artery catheterization in severely ill pregnant women: prospective comparative study and systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:25-31. [PMID: 27404397 DOI: 10.1002/uog.16015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/22/2016] [Accepted: 07/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Most severe pregnancy complications are characterized by profound hemodynamic disturbances, thus there is a need for validated hemodynamic monitoring systems for pregnant women. Pulmonary artery catheterization (PAC) using thermodilution is the clinical gold standard for the measurement of cardiac output (CO), however this reference method is rarely performed owing to its invasive nature. Transthoracic echocardiography (TTE) allows non-invasive determination of CO. We aimed to validate TTE against PAC for the determination of CO in severely ill pregnant women. METHODS This study consisted of a meta-analysis combining data from a prospective study and a systematic review. The prospective arm was conducted in Pretoria, South Africa, in 2003. Women with severe pregnancy complications requiring invasive monitoring with PAC according to contemporary guidelines were included. TTE was performed within 15 min of PAC and the investigator was blinded to the PAC measurements. Comparative measurements were extracted from similar studies retrieved from a systematic review of the literature and added to a database. Simultaneous CO measurements by TTE and PAC were compared. Agreement between methods was assessed using Bland-Altman statistics and intraclass correlation coefficients (ICC). RESULTS Thirty-four comparative measurements were included in the meta-analysis. Mean CO values obtained by PAC and TTE were 7.39 L/min and 7.18 L/min, respectively. The bias was 0.21 L/min with lower and upper limits of agreement of -1.18 L/min and 1.60 L/min, percentage error was 19.1%, and ICC between the two methods was 0.94. CONCLUSIONS CO measurements by TTE show excellent agreement with those obtained by PAC in pregnant women. Given its non-invasive nature and availability, TTE could be considered as a reference for the validation of other CO techniques in pregnant women. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. RESUMEN OBJETIVO Las complicaciones del embarazo más graves se caracterizan por trastornos hemodinámicos serios, debido a los cuales existe la necesidad de sistemas validados de monitorización hemodinámica para mujeres embarazadas. Aunque la cateterización de la arteria pulmonar (CAP) mediante termodilución es el patrón de referencia clínico para la medición del gasto cardíaco (GC), este método se usa con poca frecuencia debido a su naturaleza invasiva. La ecocardiografía transtorácica (ETT) permite la determinación no invasiva del GC. El objetivo de este estudio fue validar la ETT frente al CAP para determinar el GC en mujeres embarazadas gravemente enfermas. MÉTODOS: Este estudio consistió en un metaanálisis que combinó datos de un estudio prospectivo y una revisión sistemática. El estudio prospectivo se llevó a cabo en Pretoria (Sudáfrica) en 2003. Se incluyeron mujeres con complicaciones graves en el embarazo que requerían una monitorización invasiva mediante CAP según las directrices de ese momento. Se realizó una ETT en un plazo de 15 minutos de haber realizado el CAP y el investigador no tuvo acceso a las mediciones del CAP. Las mediciones comparativas se extrajeron de estudios similares obtenidos a partir de una revisión sistemática de la literatura y se añadieron a una base de datos. Se compararon las mediciones simultáneas del GC mediante ETT y CAP. La concordancia entre métodos se evaluó a través del método estadístico de Bland-Altman y de coeficientes de correlación intraclase (CCI). RESULTADOS Se incluyeron treinta y cuatro mediciones comparativas en el metaanálisis. Los valores medios del GC obtenidos mediante CAP y ETT fueron de 7,39 l/min y 7.18 l/min, respectivamente. El sesgo fue de 0,21 l/min, siendo los límites inferior y superior de la concordancia de -1,18 l/min y 1.60 l/min; el error porcentual fue del 19,1%, y el CCI entre ambos métodos fue de 0,94. CONCLUSIONES Las mediciones del GC en mujeres embarazadas mediante ETT muestran una excelente concordancia con las obtenidas mediante CAP. Dada su naturaleza no invasiva y su disponibilidad, la ETT podría considerarse como referencia para la validación de otras técnicas relacionadas con el GC en mujeres embarazadas. : ,。(pulmonary artery catheterization,PAC)(cardiac output,CO),,。(transthoracic echocardiography,TTE)CO。PACTTECO。 : meta。2003。PAC。PAC 15 minTTE,PAC。,。TTEPACCO。Bland-Altman(intraclass correlation coefficients,ICC)。 : meta34。PACTTECO7.39 L/min7.18 L/min。-1.18 L/min、1.60 L/min0.21 L/min,19.1%,ICC0.94。 : TTECOPACCO。,TTECO。.
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Affiliation(s)
- J Cornette
- Department of Obstetrics and Gynecology, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
- Department of Obstetrics & Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S Laker
- Department of Obstetrics and Gynecology, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynecology, Kloof Mediclinic, Gauteng, South Africa
| | - B Jeffery
- Department of Obstetrics and Gynecology, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynecology, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - H Lombaard
- Department of Obstetrics and Gynecology, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
- Department of Obstetrics and Gynecology, University of Witwatersrand, Gauteng, South Africa
| | - A Alberts
- Department of Anesthesiology and Critical Care, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
| | - D Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R C Pattinson
- Department of Obstetrics and Gynecology, Kalafong Provincial Tertiary Hospital University of Pretoria, Pretoria, South Africa
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Bajwa SJS, Kaur J. Critical care challenges in obstetrics: An acute need for dedicated and co-ordinated teamwork. Anesth Essays Res 2015; 8:267-9. [PMID: 25886319 PMCID: PMC4258962 DOI: 10.4103/0259-1162.143107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India. E-mail:
| | - Jasleen Kaur
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India. E-mail:
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Henke VG, Bateman BT, Leffert LR. Focused review: spinal anesthesia in severe preeclampsia. Anesth Analg 2013; 117:686-693. [PMID: 23868886 DOI: 10.1213/ane.0b013e31829eeef5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. Compared with healthy parturients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. In severe preeclampsia, spinal anesthesia may cause a higher incidence of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived and has not been linked to clinically significant differences in outcomes. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management.
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Affiliation(s)
- Vanessa G Henke
- UCLA Department of Anesthesiology, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403.
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Padmagirison R, Patel N, Justin W, Dharini C. Cardiac arrest precipitated by fluid challenge in a patient with unrecognised peripartum cardiomyopathy. J OBSTET GYNAECOL 2012; 33:93-4. [PMID: 23259894 DOI: 10.3109/01443615.2012.706665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Padmagirison
- Department of Obstetric and Gynaecology, St John's Hospital, Chlemsford, UK.
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Abstract
Obstetrical critical care has not been able to achieve the same level of peaks in developing nations like India, as in the western countries. Numerous factors, including clinical and economical, have played a major role in widening the gap of quality care delivery in severely ill obstetric patients, between the two extreme worlds. Moreover, this wide gap can be, to a large extent, attributable to the lower literacy rates, paucity of research in obstetrical critical care, poverty, lack of awareness, and the sociocultural and behavioral factors prevalent in these developing nations. The most common indication for Intensive Care Unit (ICU) admission of such patients throughout the world is hemorrhage, both antepartum and postpartum. Hypertensive disorders, pre-eclampsia, and its related complications are also major contributory factors for such admissions. The pattern of the disease necessitating such admissions influences maternal mortality to a great extent. The present article reviews the most common indications of obstetrical admissions to the ICU, the challenges and obstacles in the treatment of severely ill obstetric patients, their possible outcome in the developing nations, room for improvement, and the need for a change in the system for better delivery of critical care obstetrical services.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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Rucklidge MWM, Hughes RD. Central venous pressure monitoring in severe preeclampsia: a survey of UK practice. Int J Obstet Anesth 2011; 20:274. [PMID: 21641203 DOI: 10.1016/j.ijoa.2011.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/06/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
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Inverted takotsubo-like left ventricular dysfunction with pulmonary oedema developed after caesarean delivery complicated by massive haemorrhage in a severe preeclamptic parturient with a prolonged painful labour. Case Rep Anesthesiol 2011; 2011:164720. [PMID: 22606381 PMCID: PMC3350152 DOI: 10.1155/2011/164720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/29/2011] [Indexed: 11/18/2022] Open
Abstract
Inverted takotsubo cardiomyopathy (TTC), a variant of stress-induced cardiomyopathy, features transient myocardial dysfunction characterized by a hyperdynamic left ventricular apex and akinesia of the base. Herein, we describe a 38-year-old primigravida with severe preeclampsia who had active labour for 4 h followed by an emergency caesarean delivery. She developed postpartum haemorrhage due to uterine atony complicated by pulmonary oedema, which was managed with large-volume infusion and hysterectomy. Her haemodynamic instability was associated with cardiac biomarkers indicative of diffuse myocardial injury and echocardiographic findings of an “inverted” TTC. The patient was almost fully recovered one month later. Our case shows that a reversible inverted TTC may result from a prolonged painful labour. TTC should be listed in the differential diagnosis of the patient presenting with pulmonary oedema of unknown origin, especially in patients with severe preeclampsia.
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Schneider MC, Beinder E, Fauchère JC, Siegemund M. Präeklampsie, Eklampsie und HELLP-Syndrom. DIE INTENSIVMEDIZIN 2011. [PMCID: PMC7123074 DOI: 10.1007/978-3-642-16929-8_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Die Präeklampsie und die mit ihr assoziierten Krankheitsbilder Eklampsie und HELLP-Syndrom setzen Schwangere und deren Feten bedeutenden Risiken aus und zählen zu den Hauptursachen mütterlicher und fetaler Morbidität und Mortalität. Die Erkrankung kann sich ganz unterschiedlich äußern: als überwiegend mütterliches (Hypertonie, Proteinurie und weitere Organfunktionsstörungen) oder fetales Syndrom (fetale Wachstumsrestriktion, Verminderung der Fruchtwassermenge, fetale Asphyxie), aber auch als Kombination der mütterlichen und fetalen Erkrankung. Sie wird dennoch ausschließlich nach mütterlichen Kriterien eingeteilt [36]:
Schwangerschaftshypertonie: Erstmanifestation einer Hypertonie nach der 20. Schwangerschaftswoche (SSW) mit systolischen und/oder diastolischen Blutdruckwerten >140 bzw. >90 mm Hg, die 2-mal im Abstand von mindestens 6 h bei Fehlen einer Proteinurie gemessen werden. Schwangerschaftskomplikationen sind selten. Meist steigt der Blutdruck im Verlauf der Schwangerschaft nicht weiter an, bisweilen wird ein progredienter Anstieg ohne weitere Präeklampsiesymptome (außer einer möglichen fetalen Wachstumsrestriktion) beobachtet, selten die Progression in eine Präeklampsie. Postpartal normalisiert sich der Blutdruck wieder. Chronische Hypertonie: Hypertonie, die bereits vor der Schwangerschaft oder später als 12 Wochen nach der Entbindung besteht. Bei einer Pfropfpräeklampsie mit einer Inzidenz von etwa 25% sind die Risiken der Frühgeburtlichkeit, der fetalen Wachstumsrestriktion, der vorzeitigen Plazentalösung und des akuten Nierenversagens höher als bei der neu aufgetretenen Präeklampsie. Präeklampsie/Eklampsie: Schwangerschaftshypertonie mit Proteinurie, die durch >300 mg Protein im 24-h-Sammelurin bzw. durch zwei qualitative Bestimmungen (Uristix) mindestens einfach positiv im Abstand von mehr als 4 h definiert ist. Die Eklampsie als Komplikation einer schweren Präeklampsie äußert sich in tonisch-klonischen Krämpfen.
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The following abstracts were presented at the Association of Anaesthetists of Great Britain & Ireland’s Annual Congress in Harrogate, September 2010. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2010.06556.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Speksnijder L, Rutten JH, van den Meiracker AH, de Bruin RJ, Lindemans J, Hop WC, Visser W. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker of cardiac filling pressures in pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2010; 153:12-5. [DOI: 10.1016/j.ejogrb.2010.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/24/2010] [Accepted: 06/27/2010] [Indexed: 12/01/2022]
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Anesthesia in preeclampsia. Hypertens Pregnancy 2010. [DOI: 10.1017/cbo9780511902529.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Guinn DA, Abel DE, Tomlinson MW. Early goal directed therapy for sepsis during pregnancy. Obstet Gynecol Clin North Am 2008; 34:459-79, xi. [PMID: 17921010 DOI: 10.1016/j.ogc.2007.06.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sepsis is a leading cause of death in pregnancy and results in significant perinatal mortality. These deaths occur despite the younger age of pregnant patients, the low rate of comorbid conditions and the potential for effective interventions that should result in rapid resolution of illness. To date, no "evidence-based" recommendations are specific to the pregnant patient who is critically ill or septic. Optimal care for the septic patient requires a multidisciplinary team with expertise in obstetrics, maternal-fetal medicine, critical care, infectious disease, anesthesia, and pharmacy. Coordination of care and good communication amongst team members is essential. Incorporation of early goal directed therapy for suspected sepsis into obstetric practice is needed to optimize maternal and neonatal outcomes.
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Affiliation(s)
- Debra A Guinn
- Northwest Perinatal Center, 9701 SW Barnes Road, Suite 299, Portland, OR 97225, USA.
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Abstract
Acute Heart Failure is a major cause of hospitalisation, with a rate of death and complications. New guidelines have been developed in order to diagnose and treat this disease. Despite these efforts pathophysiology and treatments options are still limited. There is agreement among the experts that increasing the cardiac output and the stroke volume without fluid overloading the patient should be the goal of every treatment. Despite this, there is no agreement on how to monitor the cardiac function and how to follow it after a therapeutic intervention. In other fields of critical care cardiovascular monitoring and application of early goal directed protocols showed benefits. This review explores the available possibilities of how to monitor the cardiac function in Acute Heart Failure. Standard and more advanced techniques are presented. Cardiac output monitors from the pulmonary artery catheter to the pulse pressure analysis and Doppler techniques are discussed, with focus on this specific clinical setting. Undoubtedly monitoring is valuable tool, but without a protocol of how to manipulate the haemodynamics, no monitor will prove alone to be beneficial. Haemodynamic driven early goal directed therapy are largely awaited in this field of medicine.
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Affiliation(s)
- Maurizio Cecconi
- Department of Intensive Care Medicine, St George's Hospital, London, SW17 0QT, UK
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Abstract
The principles enshrined in existing trauma resuscitation protocols for treating nonpregnant trauma victims should also be applied to the pregnant patient. In addition, left tilt of the pregnant patient (or the back board) and supplement oxygen are mandatory. The patient should be treated by a multidisciplinary team, preferably in a trauma center. Early intubation is recommended, but should be performed, where possible, by an experienced physician. The physician should be aware of the different physiologic and laboratory values in normal pregnancy. Fetal monitoring is important to assess both fetal and maternal welfare. Imaging examinations, where indicated, should not be delayed. Even minor maternal trauma, especially if caused by interpersonal violence, might cause fetal loss.
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Affiliation(s)
- Yuval Meroz
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, POB 12000, Ein Karem, Jerusalem 91120, Israel
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Abstract
INTRODUCTION Obstetric patients are generally young and healthy. However, the potential for catastrophic complications is real, and despite the therapeutic advances of the last few decades, maternal morbidity and mortality continue to occur. This may be related to the pregnancy itself, aggravation of a preexisting illness, or complications of the (operative) delivery. PURPOSE The purpose of this review is two-fold: first, to provide an update on currently available reports pertaining to important critical care issues of the obstetric patient population and, second, to present current comprehensive treatment options for preeclampsia and massive obstetric hemorrhage because both are responsible for the majority of maternal mortality and morbidity worldwide. RESULTS The most common reasons for intensive care unit admission are hypertensive disorders and massive obstetric hemorrhage. Timely delivery and prompt initiation of antihypertensive therapy for severe hypertension form the mainstay of care in preeclampsia. Restoration of circulating blood volume and rapid control of bleeding and impaired coagulation are the main factors in the management of massive obstetric hemorrhage. Puerperal morbidity has become the main topic of quality of care issues in maternity care. Although the Acute Physiology and Chronic Health Evaluation II score is commonly used in the intensive care unit, it does not seem to be appropriate for pregnant women because it overestimates their mortality rates. A high-dependency care unit suits the needs for at least half of the obstetric patient population in need of higher acuity care and will save considerable cost. CONCLUSION Emphasis on early detection of maternal problems and prompt referral to tertiary centers with intensive care unit facilities to provide optimum care of the circulation, blood pressure, and respiration at an early stage could minimize the prevalence of multiple organ failure and mortality in critically ill obstetric patients.
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Affiliation(s)
- Gerda G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center, Groningen, The Netherlands
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Martin SR, Foley MR. Intensive care in obstetrics: an evidence-based review. Am J Obstet Gynecol 2006; 195:673-89. [PMID: 16949397 DOI: 10.1016/j.ajog.2006.05.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/05/2006] [Accepted: 05/30/2006] [Indexed: 11/26/2022]
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Tuffnell DJ, Jankowicz D, Lindow SW, Lyons G, Mason GC, Russell IF, Walker JJ. Outcomes of severe pre-eclampsia/eclampsia in Yorkshire 1999/2003. BJOG 2005; 112:875-80. [PMID: 15957986 DOI: 10.1111/j.1471-0528.2005.00565.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish the risk of serious complications from severe pre-eclampsia and eclampsia in a region using a common guideline for the management of these conditions. DESIGN A five-year prospective study. SETTING Sixteen maternity units in Yorkshire. POPULATION All women managed with severe pre-eclampsia and eclampsia. METHODS A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data. MAIN OUTCOME MEASURE Incidence of the conditions and serious complication rates. RESULTS A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003. One thousand eighty-seven women were diagnosed with severe pre-eclampsia or eclampsia (5.2/1000). One hundred and fifty-one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty-five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty-five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug. CONCLUSION A regional guideline for severe pre-eclampsia and eclampsia can be developed and implemented. Its use may contribute to a low rate of serious complications.
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Affiliation(s)
- D J Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Wong AYC, Chan RSN, Irwin MG. Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. Can J Anaesth 2004; 51:923-7. [PMID: 15525619 DOI: 10.1007/bf03018892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. CLINICAL FEATURES A 28-yr-old parturient with a history of thrombocytopenia was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema) at 25 weeks of gestation. Laboratory studies revealed pancy-topenia (hemoglobin 6.4 g.dL(-1), white cell count 3.43 x 10(9).L(-1), platelet count 20 x 10(9).L(-1)) and bone marrow biopsy showed hypoplastic anemia. As pre-eclampsia worsened, a Cesarean delivery was performed at 27 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 600 mL and a live female baby was delivered. Postoperatively her blood pressure and neurological symptoms improved but thrombocytopenia remained at discharge. CONCLUSIONS Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.
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Affiliation(s)
- Andrew Y C Wong
- Department of Anaesthesiology F2, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:145-63. [PMID: 12698838 DOI: 10.1016/s0889-8537(02)00054-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Severe pre-eclampsia is a complex disease, which taxes the expertise of even the most experienced obstetric anesthesiologist. The treatment should focus on stabilization of blood pressure, optimization of fluid status, and prevention of convulsions. Neuraxial blocks for labor and delivery offer many benefits to the mother and her infant. For cesarean section, there is unequivocal evidence of superiority of neuraxial anesthesia over general anesthesia. If general anesthesia is needed, careful preanesthetic preparation and meticulous airway management is essential. The successful and safe peripartum management of the pre-eclamptic patient and her infant is a team effort among the anesthesiologist, obstetrician, and neonatologist.
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Affiliation(s)
- Jaya Ramanathan
- Department of Anesthesiology, Department of Obstetrics and Gynecology, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA.
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Galloway S, Lyons G. Preeclampsia complicated by placental abruption, HELLP, coagulopathy and renal failure – further lessons. Int J Obstet Anesth 2003; 12:35-9. [PMID: 15676318 DOI: 10.1016/s0959-289x(02)00134-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2002] [Indexed: 10/27/2022]
Abstract
We present a case of preeclampsia complicated by HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome and marked coagulopathy. The severity of the coagulopathy and haemolysis made renal failure and pulmonary oedema inevitable. We identified a number of discussion points in this case. These were the delay to appreciate the haemolysis, the severity of the haemolysis and its interaction with the treatment of coagulopathy and the conservative management of pulmonary oedema. At these points there were shortcomings in our management of this complex case that merit further discussion.
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Affiliation(s)
- S Galloway
- Department of Anaesthesia, St James's University Hospital, Leeds, UK.
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de Laforcade AM, Rozanski EA. Central venous pressure and arterial blood pressure measurements. Vet Clin North Am Small Anim Pract 2001; 31:1163-74, vi. [PMID: 11727332 DOI: 10.1016/s0195-5616(01)50098-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial blood pressure measurement and central venous pressure monitoring are important tools in the management of the critically ill pet. Central venous pressure is reflective of right atrial pressure and provides information concerning volume status. Arterial blood pressure is helpful in determining if perfusion to vital tissues is adequate. By providing more information with which to tailor fluid therapy and by prompt recognition of hypo- or hypertension, these monitoring tools are instrumental in the management of the critically ill pet.
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Affiliation(s)
- A M de Laforcade
- Section of Intensive Care, Department of Clinical Sciences, Tufts University School of Veterinary Medicine, North Grafton, Massachusetts, USA.
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Young P, Johanson R. Haemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient. Best Pract Res Clin Obstet Gynaecol 2001; 15:605-22. [PMID: 11478818 DOI: 10.1053/beog.2001.0203] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To determine the clinical usefulness of invasive and non-invasive haemodynamic assessment in pre-eclampsia. METHOD A systematic review of the literature was undertaken, using a MEDLINE electronic search using a combination of MESH headings and textwords. Over 1500 abstracts were perused; we obtained 156 full papers that were related to the subject matter. Of the full papers, 55 yielded relevant information. Hand-searching the reference lists of the retrieved papers completed the search. RESULTS There are no data from randomized controlled clinical trials illustrating the clinical usefulness of pulmonary artery catheters or echocardiographic techniques in hypertensive pregnancy. There are a wealth of data illustrating the haemodynamic profiles of both untreated and treated pre-eclamptic women. Data are also available comparing right heart and left heart filling pressures, demonstrating a relatively poor correlation between the two values. The clinical impact of either measurement is unclear. Data are available illustrating the correlation between echocardiographic techniques and pulmonary artery catheterization.
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Affiliation(s)
- P Young
- North Staffordshire Maternity Unit, Newcastle Road, Stoke on Trent, Staffs, ST4 6QG, UK
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