Best practice & research. Clinical obstetrics & gynaecology
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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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The present chapter considers the evolving role of critical care outreach in the general hospital setting and applied to obstetric patients, the mechanics of transferring critically ill obstetric patients to critical care and radiology areas, the scoring systems in use in critical care, and the difficulties in applying these scoring systems to obstetric patients.
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In the last 20 years, in developed countries, maternal mortality rates have fallen such that analysis of cases of severe maternal morbidity is necessary to provide sufficient numbers to give a clinically relevant assessment of the standard of maternal care. Different approaches to the audit of severe maternal morbidity exist, and include need for intensive care, organ system dysfunction and clinically defined morbidities. ⋯ The death to severe morbidity ratio may reflect the standard of maternal care. Audits of severe maternal morbidity should be complementary to maternal mortality reviews.
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Best Pract Res Clin Obstet Gynaecol · Jun 2008
Maternal mortality in well-resourced countries: is there still a need for confidential enquiries?
The low maternal mortality rates in well-resourced countries are not an automatic consequence of prosperity. Morbidity cannot be avoided and preventing mortality requires good medical care. Now that deaths are infrequent in these countries, people expect investigation of every case and action to make pregnancy even safer. ⋯ Analysis is by practising clinicians from many specialties and recommendations are disseminated to clinicians, managers, politicians and the public. The confidential enquiry method has now been adopted by other specialties and by many countries. In countries without confidential enquiries there is under-reporting of maternal mortality, particularly among the poor.