title: The management of the critically ill obstetric patient.
abstract: Hypertensive disorders, postpartum hemorrhage, and sepsis are the most common indications for intensive care unit admission among obstetric patients. In general, ICU mortality is low, and better than would be predicted using available mortality prediction tools. Provision of care to this special population requires an intimate understanding of physiologic changes that occur during pregnancy. Clinicians must be aware of the way various diagnostic and treatment choices can affect the mother and fetus. Most clinically necessary radiographic tests can be safely performed and fall under the maternal radiation exposure limit of less than 0.05 Gray (Gy). Careful attention must be paid to acid-base status, oxygenation, and ventilation when faced with respiratory failure necessitating intubation. Cesarean delivery can be justified after 4 minutes of cardiac arrest and may improve fetal and maternal outcomes. The treatment of obstetric patients in the ICU introduces complexities and challenges that may be unfamiliar to many critical care physicians; teamwork and communication with obstetricians is crucial.
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT 06520, USA. shyoko.honiden@yale.edu
authors.forename: Shyoko
authors.initials: S
authors.lastname: Honiden
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Abdel-Razeq
authors.forename: Mark D
authors.initials: MD
authors.lastname: Siegel
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic; D009774:Obstetrics; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control