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Poisoning in Pregnancy

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Critical Care Toxicology

Abstract

It has been said that managing a pregnant patient involves managing two patients at once, the mother and the fetus. This dual management paradigm is often seen as a complex balancing act, benefits to the mother against risks to the fetus and vice versa. In the setting of poisoned patients, this takes on an even greater complexity, especially given the relative lack of literature to support or refute any given treatment recommendation. The higher acuity of the critically ill patient brings this situation to its sharpest point as the death of mother, fetus, or both becomes an ever more likely possibility. This chapter will discuss specific recommendations in greater detail, but as a general rule, the best approach to all poisoned pregnant patients is to treat the mother in the same way as if she were not pregnant. Improved maternal survival will typically lead to improved fetal survival.

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Authors and Affiliations

  1. Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA

    Kevin F. Maskell Jr. & Kirk L. Cumpston

  2. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital Faculty, Harvard Medical School and Harvard Humanitarian Initiative, Boston, MA, USA

    Timothy B. Erickson

  3. University of Chicago Pritzker School of Medicine, Glenview, IL, USA

    Jerrold B. Leikin

Authors
  1. Kevin F. Maskell Jr.
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  2. Kirk L. Cumpston
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  3. Timothy B. Erickson
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  4. Jerrold B. Leikin
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Correspondence to Kevin F. Maskell Jr. , Kirk L. Cumpston , Timothy B. Erickson or Jerrold B. Leikin .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Maskell, K.F., Cumpston, K.L., Erickson, T.B., Leikin, J.B. (2017). Poisoning in Pregnancy. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_40

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