title: Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy.
abstract: In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.
authors.affiliation: Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France. Electronic address: laurent.zieleskiewicz@ap-hm.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Zieleskiewicz
authors.affiliation: Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, DHU Risques et grossesse, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Chantry
authors.affiliation: Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
authors.forename: Gary
authors.initials: G
authors.lastname: Duclos
authors.affiliation: Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Bourgoin
authors.affiliation: Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mignon
authors.affiliation: Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.affiliation: Service d'anesthésie et de réanimation, Aix Marseille université, hôpital Nord, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
mesh_terms: D000328:Adult; D000758:Anesthesia; D019090:Case Management; D002585:Cesarean Section; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000628:therapy*
keywords: Cardiac arrest; Critical care; Epidemiology; Pregnancy; Sepsis; Ultrasound