Critical Care Obstetrics

A new edition of the proven guide to providing emergency care for mothers-to-be in acute medical distress

Now in its sixth edition, Critical Care Obstetrics offers an authoritative guide to what might go seriously wrong with a pregnancy and delivery and explains how to manage grave complications. Written by an international panel of experts, this updated and revised edition contains the most recent advances in the field as well as recommendations for treating common complications such as bleeding, thrombosis, trauma, acute infection, airway problems and drug reactions in a pregnant patient.

This important guide offers the information needed to enable the early-on recognition of life-threatening conditions and the use of immediate life-saving treatments in emergency situations. The techniques and procedures outlined help to maximise the survival prospects of both the mother and fetus. The authors offer an accessible text for any healthcare professional responsible for the care and management of pregnant women and their unborn children. Critical Care Obstetrics is a vital resource that:

• Contains a clear guide for early recognition of conditions which may prove life threatening
• Offers new information on Analgesia and sedation; Imaging and interventional radiology in pregnancy; Oxygen therapy; and Pulmonary hypertension
• Presents protocols for implementing life-saving treatments in emergency situations
• Written by international experts in emergency obstetric medicine

Designed for use by obstetricians and obstetrician and gynecology trainees, Critical Care Obstetrics is the updated guide to the management of serious conditions in pregnancy and delivery.

Jeffrey P. Phelan MD, President and Director of Clinical Research, Childbirth Injury Prevention Foundation, Glendora, CA, USA; San Gabriel Valley Perinatal Medical Group, Inc, West Covina, CA, USA; Former Director of Quality Assurance, Department of Obstetrics and Gynecology, Citrus Valley Medical Center, West Covina, CA, USA

Luis D. Pacheco MD, Professor of Departments of Obstetrics, Gynecology, and Anesthesiology, Divisions of Maternal Fetal Medicine and Surgical Critical Care, The University of Texas Medical Branch, Galveston, TX, USA

Michael R. Foley MD, Professor and Chair, Department of Obstetrics and Gynecology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA

George R. Saade MD, Professor of Obstetrics & Gynecology, and Cell Biology, Chief of Obstetrics and Maternal Fetal Medicine, The University of Texas Medical Branch, Galveston, TX, USA

Gary A. Dildy MD, Professor of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA

Michael A. Belfort MBBCH, MD, PhD, Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA

List of Contributors ix

Foreword to the Sixth Edition xvii

Part One Basic Critical Care Clinical and Surgical Principles 1

1 Epidemiology of Critical Illness in Pregnancy 3
Cande V. Ananth and John C. Smulian

2 Organizing an Obstetrical Critical Care Unit: Care without Walls 17
Julie Scott and Michael R. Foley

3 Critical Care Obstetric Nursing 27
Nan H. Troiano and Suzanne McMurtry Baird

4 Pregnancy‐Induced Physiologic Alterations 41
Errol R. Norwitz and Julian N. Robinson

5 Maternal Blood Gas Physiology 69
Aaron B. Caughey

6 Fluid and Electrolyte Balance 87
William E. Scorza, Sharon Maynard, and Anthony Scardella

7 Interventional Radiology in Pregnancy 115
Sheena A. Pimpalwar and Michael A. Belfort

8 Fetal Considerations in the Critically Ill Gravida 123
Jeffrey P. Phelan

9 Fetal Effects of Drugs Commonly Used in Critical Care 151
Sarah Gloria Običan and Jerome Yankowitz

10 Maternal‐Fetal Oxygenation 175
Alfred D. Fleming and Marsha Henn

11 Cardiopulmonary Resuscitation (CPR) in Pregnancy 183
Terri‐Ann Bennett and Carolyn M. Zelop

12 Neonatal Resuscitation 193
Jay P. Goldsmith and Gilbert I. Martin

13 Ventilator Management in Critical Illness 215
Luis D. Pacheco and Antonio Saad

14 Vascular Access 249
Gayle Olson and Aristides P. Koutrouvelis

15 Nutritional Support 265
Bill Tang, Michael J. Tang, and Jeffrey P. Phelan

16 Dialysis in Pregnancy 273
Evan I. Fisher, Shad H. Deering, and James D. Oliver III

17 Cardiopulmonary Bypass 285
Alexis L. McQuitty

18 Noninvasive Monitoring in Critical Care 303
Amir Shamshirsaz and Michael A. Belfort

19 Obstetric Analgesia and Anesthesia 315
M. James Lozada, Rovnat Babazade, and Rakesh B. Vadhera

20 Critical Care Drills in Obstetrics 331
Monica A. Lutgendorf and Shad H. Deering

21 Maternal‐Fetal Transport in the High‐Risk Pregnancy 347
Albert P. Sarno, Joshua A. Makhoul, and John C. Smulian

Part Two Acute Emergencies 359

22 Seizures and Status Epilepticus 361
Michael W. Varner

23 Acute Spinal Cord Injury 369
Lisa R. Wenzel, Angela Vrooman, and Hunter A. Hammill

24 Severe Acute Asthma 391
Dharani K. Narendra and Nicola A. Hanania

25 Acute Respiratory Distress Syndrome in Pregnancy 403
Dharani K. Narendra, David Muigai, and Kalpalatha K. Guntupalli

26 Cardiogenic Pulmonary Edema 419
Wayne J. Franklin and William C. Mabie

27 The Acute Abdomen during Pregnancy 429
Ibrahim A. Hammad and Howard T. Sharp

28 Acute Pancreatitis 441
Anna S. Leung and Jeffrey P. Phelan

29 Acute Renal Injury 457
Kristen L. Elmezzi, Caroline C. Marrs, C. Luke Dixon, Shad H. Deering, and Giuseppe Chiossi

30 Acute Fatty Liver of Pregnancy 471
Ibrahim A. Hammad and T. Flint Porter

31 Disseminated Intravascular Coagulation 479
Nazli Hossain and Michael J. Paidas

32 Endocrine Emergencies 487
Mary Catherine Tolcher, Heather S. Hoff, and Kjersti Marie Aagaard

33 Acute Psychiatric Conditions in Pregnancy 501
Lucy J. Puryear

34 Diabetic Ketoacidosis 519
Mark A. Curran

Part Three Shock in Pregnancy 533

35 Hypovolemic Shock 535
Jerasimos Ballas and Scott Roberts

36 Blood Component Therapy and Massive Transfusion 547
Shiu‐Ki Rocky Hui, Kjersti Marie Aagaard, and Jun Teruya

37 Etiology and Management of Hemorrhage 569
Irene A. Stafford, Michael A. Belfort, and Gary A. Dildy

38 Septic Shock 599
Sonya S. Abdel‐Razeq and Errol R. Norwitz

39 Cardiogenic Shock 631
Scott Roberts and Martha W.F. Rac

40 Anaphylactic Shock in Pregnancy 641
Raymond O. Powrie

41 Amniotic Fluid Embolism 653
Gary A. Dildy, Michael A. Belfort, and Steven L. Clark

Part Four Medical and Surgical Management 671

42 Pregnancy‐Related Stroke 673
Jamil ElFarra and James N. Martin, Jr.

43 Cardiac Disease and Pregnancy 699
Wayne J. Franklin, Roxann Rokey, Michael R. Foley, and Michael A. Belfort

44 Anesthetic Considerations in the Critically Ill Gravida with Cardiac Disease 731
Shobana Murugan, Lisa Mouzi Wofford, Sandeep Markan, and Yi Deng

45 Thromboembolic Disease 755
Martha Pritchett Mims

46 Pulmonary Hypertension in Pregnancy 775
Mohammed F. Zaidan and Alexander G. Duarte

47 Sickle Cell Disease and Pregnancy 791
Iberia Romina Sosa and Mark M. Udden

48 Thrombotic Thrombocytopenic Purpura, Hemolytic‐Uremic Syndrome, and HELLP 803
Kelty R. Baker

49 The Placenta as a Critical Care Issue 821
Karin A. Fox, Martha W.F. Rac, Alireza A. Shamshirsaz, and Michael A. Belfort

50 Complications of Preeclampsia 837
Mary Catherine Tolcher, Hector Mendez‐Figueroa, and Kjersti Marie Aagaard

51 Systemic Lupus Erythematosus and Antiphospholipid Syndrome 873
Fawzi Saoud and Maged M. Costantine

52 Trauma in Pregnancy 891
Robert Rossi, Alfredo F. Gei, and James W. Van Hook

53 Thermal and Electrical Injury 919
Cornelia R. Graves

54 Overdose, Poisoning, and Envenomation during Pregnancy 927
Alfredo F. Gei, Victor R. Suarez, and James W. Van Hook

55 The Organ Transplant Patient in the Obstetric Critical Care Setting 985
Calla Holmgren and James R. Scott

56 Fetal Surgery Procedures and Associated Maternal Complications 997
Alireza A. Shamshirsaz, Venkata Bandi, David Muigai, R. H. Ball, and Michael A. Belfort

57 Cancer in the Pregnant Patient 1005
Kristin Bixel, Kenneth H. Kim, and David M. O’Malley

58 Mass Casualties and the Obstetrical Patient 1023
Lisa M. Foglia and Peter E. Nielsen

59 Biological, Chemical, and Radiological Exposures in Pregnancy 1027
Lisa M. Foglia and Peter E. Nielsen

Part Five Ethical and Legal Considerations 1037

60 Ethics in the Obstetric Critical Care Setting 1039
Fidelma B. Rigby

61 Medical‐Legal Considerations in Critical Care Obstetrics 1063
Jeffrey P. Phelan

Index 1085

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