Best practice & research. Clinical obstetrics & gynaecology
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The aims of critical care management are broad. Critical illness in pregnancy is especially pertinent as the patient is usually young and previously fit, and management decisions must also consider the fetus. Assessment must consider the normal physiological changes of pregnancy, which may complicate diagnosis of disease and scoring levels of severity. ⋯ There are also increasing numbers of pregnancies in those with high-risk medical conditions such as cardiac disease. As numbers are small and clinical trials in pregnancy are not practical, management in most cases relies on general intensive care principles extrapolated from the non-pregnant population. This chapter will outline the aims of management in an organ-system-based approach, focusing on important general principles of critical care management with considerations for the pregnant and puerperal patient.
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Best Pract Res Clin Obstet Gynaecol · Oct 2008
ReviewCritical care in obstetrics: pregnancy-specific conditions.
This chapter summarizes the clinical presentation, pathophysiology, evaluation and management of six commonly encountered complications unique to pregnancy that require critical care management: obstetric haemorrhage; pre-eclampsia/HELLP (haemolysis-elevated liver enzymes-low platelets) syndrome; acute fatty liver of pregnancy; peripartum cardiomyopathy; amniotic fluid embolism; and trauma.
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Best Pract Res Clin Obstet Gynaecol · Oct 2008
ReviewMultidisciplinary training in obstetric critical care.
Once identified, the critically ill obstetric patient will often fare well. Unfortunately, several recent publications show that many such patients are not identified and come to harm. Training for those caring for pregnant women has changed in recent years. ⋯ Other medical staff (anaesthetists, intensivists) may have experience of critical care in non-pregnant patients, but may be less aware of physiological changes of pregnancy that can affect how these patients are managed. The best way to address these issues is with multidisciplinary training, as highlighted in 'Safer Childbirth' and 'Saving Mothers Lives'. Such training allows each team member to understand his/her role and that of each of the other disciplines involved.
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Infections in critically ill obstetric patients are observed worldwide, although the incidence, aetiology and patient outcome vary between geographic locations. This chapter focuses on sepsis, with emphasis on the pathophysiology, outcome and specific management issues.
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Best Pract Res Clin Obstet Gynaecol · Oct 2008
Role of the midwife and the obstetrician in obstetric critical care - a case study from the James Cook University Hospital.
The role of the obstetrician and the midwife are fundamental to the successful antenatal management, delivery and postpartum management of the critically ill obstetric patient. However, there is a dearth of published literature on the integrated management of these roles. This chapter addresses these issues by reporting on experiences at James Cook University Hospital in developing a more holistic approach to patient management and critical care through appraisal of these roles, and resulting extension of the role of the midwife to encompass physiological assessment, understanding the effects of pregnancy on disease, interpretation of, and acting on, blood results including arterial gases, and development of the service through the development of guidelines and undertaking audits. ⋯ The resulting development of the role of the obstetrician encompasses leadership, clinical knowledge, documentation, guideline development, risk management and the communication functions of debrief, audit and education. Development of the roles has reduced admissions to intensive care and increased patient satisfaction and adherence to policies at James Cook University Hospital. This paper provides a critical appraisal of this role development and discusses some of the lessons learned.