Neurocritical Illness During Pregnancy and Puerperium

Chapter

Abstract

Critical care support and admission to an ICU is a relatively infrequent occurrence during pregnancy and the postpartum period Retrospective analyses of hospital admissions and complication rates indicate that 0.11–1.1% of deliveries are complicated by maternal ICU admission Patient demographics and hospital type clearly vary and affect outcomes differently; therefore, understanding the true risk of obstetric complications is somewhat difficult Literature suggests that these complications may account for most or only a portion of ICU admissions in pregnant patients (i.e., 19–93%); however, it is clear that maternal morbidity and mortality can be substantial when pregnant women require critical care In one study, 71% of obstetric patients transferred to the ICU required ventilatory support; other studies that indicate mortality ranges from 5 to 20% Treatment of critically ill pregnant women is challenged by limited information regarding safety profiles of therapeutic agents and the necessity to simultaneously manage mother and pregnancy viability Survival depends on care algorithms that allow for early detection of maternal problems and prompt referral to tertiary centers with ICUs Proactive and aggressive measures, including optimal cardiopulmonary management, minimize the incidence of multiorgan failure and mortality Admission criteria for appropriate triage are essential; decisions may be based on several models (which utilize prioritization) or diagnostic and objective parameters The American College of Critical Care Medicine summarized qualifications for ICU admission; this diagnostic model (Table 33.1) uses specific conditions or diseases to determine appropriateness of ICU admission General criteria for admission to an obstetric intermediate care unit are listed in Table 33.2

Keywords

Critically ill pregnant women Altered mental status Coma Seizures Parálisis Intracranial vascular anomaly Eclampsia 

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Forsyth Comprehensive NeurologyWinston-SalemUSA
  2. 2.Neurocritical Care ProgramNovant Health Systems, Forsyth Medical CenterWinston-SalemUSA

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