Critical Care in Obstetrics: Where are We

Abstract

Maternal mortality is disastrous news for the society, family, newborn, and the obstetrician. Yet, we all who are care providers to these apparently healthy women carrying another life within them are dumbfounded by the clinical conditions arising due to the pregnancy or the effects of the pregnancy, that it becomes difficult to provide an ideal care to them. The rapid uprising of a condition and the worsening of commonly occurring benign conditions-preeclampsia, hemorrhage, etc., necessitates that all obstetricians are well versed with the physiological changes and should be able to not only provide the best of obstetric care to the mother and the newborn but also perform or assist in performance of life-saving procedures.

Role of Critical Care Units in the management of obstetric patients (Review)

“…They represent both severe conditions that can have detrimental effects on the health of both mother and the fetus, as well as being associated with significantly high morbidity and mortality rates. HELLP syndrome may imitate a plethora of non-obstetric disorders (27). Diagnosis is based on the clinical symptoms including hypertension (15% of patients with HELLP syndrome exhibit blood pressure within normal ranges), malaise, nausea and epigastric pain (28), along with the laboratory findings of microangiopathic hemolysis (schistocytes, peripheral swear, low serum hemoglobin and elevated lactate dehydrogenase), elevated levels of serum glutamic-oxalacetic transaminase/serum glutamic-pyruvic transaminase (up to 70 IU/l) and low platelets (<100,000/µl).…”

“…A rate of 80 ml/h intravenous fluid administration has been proposed by certain studies, although there is insufficient evidence in this field (32). The final treatment for the aforementioned conditions is to proceed with the delivery as soon as possible, whilst simultaneously taking into account the viability of the fetus and the ability to administer corticosteroids to ensure lung maturation (27).…”

“…Massive hemorrhaging and the subsequent hypovolemic shock are also considered amongst the leading causes for admission to CCUs, amongst the obstetric population. Massive hemorrhaging can occur either during the antepartum period primarily due to a ruptured ectopic pregnancy, placental abruption or pathological invasion of the placenta (placenta accreta), or during the postpartum course (27). Postpartum hemorrhage (PPH) is a primary cause of maternal mortality (30).…”

Saúde ocupacional da equipe de enfermagem obstétrica intensiva durante a pandemia da Covid-19

“…Ademais, pode-se ressaltar que os cuidados obstétricos críticos envolvem particularidades que aumentam os riscos aos profissionais, como a exposição à perda sanguínea no pós-parto; portanto, o uso contínuo de todos os EPIs pela equipe torna-se extremamente necessário (17).…”

“…Destarte, além do sofrimento psicológico, do desgaste mental e físico, há cada vez mais exigências e sobrecargas aos profissionais de enfermagem para a melhoria da gestão de cuidados e a liderança das equipes de saúde atuantes no enfrentamento da Covid-19 (5,7). Essas exigências já faziam parte do cotidiano dos profissionais nesse cenário, visto que a morbidade e mortalidade maternas são consideradas problemas de saúde pública em todo o mundo (17). No entanto, a pandemia agravou a situação, com a necessidade urgente de medidas mais cautelosas para o cuidado dispensado a essas mulheres em situação de vulnerabilidade intensa (6).…”