Managing cardiac emergencies in pregnancy

Sepsis is a leading cause of maternal morbidity and mortality, globally and in the UK. In pregnancy and the puerperium, women may be more susceptible to rapid deterioration of illness following an infection. Sepsis has a complex pathophysiology and the immunological and cardiovascular adaptations of normal pregnancy may have an adverse impact on the maternal response to infection. Furthermore, physiological changes of pregnancy, which mimic those of sepsis, often delay recognition and optimal management. 'Bedside' identification of pathogens and their antibiotic resistance patterns may help to improve clinical outcomes. Recent updates in sepsis management, areas of controversy and the importance of translational research and clinical trials for pregnancy and the puerperium are discussed. Learning objectivesTo highlight the difficulties of diagnosing sepsis in pregnancy. To highlight recent updates, new definitions and controversies of current sepsis management. To highlight the potential for research to develop novel biomarkers and therapeutic agents specific to the pregnant woman. Ethical issuesSepsis research involving new technologies differentially benefits high-income countries compared with low-/middle-income countries despite the greatest burden of maternal sepsis being in the latter. With the current rapid evolution of omic technology platforms, greater affordability will provide greater accessibility.

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“…Currently, there is a lack of safety or efficacy evidence to recommend using this drug in obstetrics. 71…”

Section: Vasopressorsmentioning

confidence: 99%

Maternal sepsis update: current management and controversies

Greer

Shah

Johnson

2019

The Obstetric & Gynaecologis

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“…Treatment will vary depending on whether a woman is pregnant or postpartum, as once mothers have delivered there is no longer a concern about fetal stability/maturity or teratogenicity of medications and more standard HF therapies can be initiated (Figure 6 ). 67 , 68 , 73 , 74 An extensive review of the medication use in pregnancy is beyond the scope of this article but has been reviewed recently. 75 In patients with stable HF, medical treatment approach parallels that of nonpregnant patients; however, there is a need to avoid teratogenic drugs (angiotensin‐converting enzyme inhibitors, angiotensin II receptor blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, atenolol, direct factor Xa inhibitors).…”

Section: Therapeutics and Principles Of Managementmentioning

confidence: 99%

Maternal Heart Failure

Bright

Lima

Avila

et al. 2021

JAHA

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Heart failure (HF) remains the most common major cardiovascular complication arising in pregnancy and the postpartum period. Mothers who develop HF have been shown to experience an increased risk of death as well as a variety of adverse cardiac and obstetric outcomes. Recent studies have demonstrated that the risk to neonates is significant, with increased risks in perinatal morbidity and mortality, low Apgar scores, and prolonged neonatal intensive care unit stays. Information on the causal factors of HF can be used to predict risk and understand timing of onset, mortality, and morbidity. A variety of modifiable, nonmodifiable, and obstetric risk factors as well as comorbidities are known to increase a patient's likelihood of developing HF, and there are additional elements that are known to portend a poorer prognosis beyond the HF diagnosis. Multidisciplinary cardio‐obstetric teams are becoming more prominent, and their existence will both benefit patients through direct care and increased awareness and educate clinicians and trainees on this patient population. Detection, access to care, insurance barriers to extended postpartum follow‐up, and timely patient counseling are all areas where care for these women can be improved. Further data on maternal and fetal outcomes are necessary, with the formation of State Maternal Perinatal Quality Collaboratives paving the way for such advances.

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“… 10 There is a gap in the literature regarding the choice of a specific inotrope to manage acute heart failure during pregnancy, especially due to safety concerns. 70 Therefore, the selection of an inotrope should be based upon the clinical scenario.…”

Section: Pulmonary Edema In Preeclampsiamentioning

confidence: 99%