La embarazada grave

Los resultados maternos en pacientes obstétricas en estado crítico: un desafío único


Maternal outcomes in critically ill obstetrics patients: A unique challenge.
Bhadade R, de' Souza R, More A, Harde M.
Indian J Crit Care Med [serial online] 2012 [cited 2012 Jul 25];16:8-16.


Background: A pregnant woman is usually young and in good health until she suffers from some acute injury. Her prognosis will hopefully be better if she receives timely intensive care. Materials and Methods: The aims of this study were to study the indications of medical intensive care unit (MICU) transfers for critically ill pregnant and postpartum females, biochemical and hematological profile, organ failure, ICU interventions, outcome of mother/fetus, APACHE II score and its correlation with mortality. Study Design and Setting: It is a prospective observational study, carried out in the MICU of a tertiary care teaching hospital over a period of 18 months. One hundred and twenty-two pregnant and postpartum females (up to 42 days after delivery) were studied. Results and Conclusion: Maternal age >30 years was associated with high mortality (68.2%). Majority of the females were admitted in the third trimester (50 patients) and postpartum period (41 patients), and mortality was highest in the postpartum period (39%). Increasing parity and gravida was associated with significantly high mortality (59.5%). Acute viral hepatitis E (45 patients) was most common indication for MICU transfer, followed by malaria and pregnancy-induced hypertension. The mortality rate was 30.3%. The most common cause of death was acute viral hepatitis E (24 patients), with hepatic failure (53 patients) being the most common organ failure. Majority of the females (88 patients) were ANC registered. Low Glasgow coma score and high APACHE II score on admission were associated with significantly high mortality (85.2%). Prompt treatment with oseltamivir in H1N1 infection was associated with good maternal and fetal outcomes.
Keywords: Critical illness, hepatitis, infection, pregnancy-induced hypertension
http://www.ijccm.org/text.asp?2012/16/1/8/94416


http://www.ijccm.org/temp/IJCCM1618-5226805_143108.pdf

Paro cardiaco y embarazo


Cardiac arrest and pregnancy
Campbell TA, Sanson TG.
J Emerg Trauma Shock [serial online] 2009 [cited 2012 Jul 25];2:34-42

Cardiopulmonary arrest in pregnancy is rare occurring in 1 in 30,000 pregnancies. When it does occur, it is important for a clinician to be familiar with the features peculiar to the pregnant state. Knowledge of the anatomic and physiologic changes of pregnancy is helpful in the treatment and diagnosis. Although the main focus should be on the mother, it should not be forgotten that there is another potential life at stake. Resuscitation of the mother is performed in the same manner as in any other patient, except for a few minor adjustments because of the changes of pregnancy. The specialties of obstetrics and neonatology should be involved early in the process to ensure appropriate treatment of both mother and the newborn. This article will explore the changes that occur in pregnancy and their impact on treatment. The common causes of maternal cardiac arrest will be discussed briefly.
Keywords: Cardiac arrest, cardiopulmonary arrest, pregnancy, resuscitation
http://www.onlinejets.org/text.asp?2009/2/1/34/43586


Paciente obstétrica grave. Conceptos recientes


The critically ill obstetric patient - Recent concepts.
Trikha A, Singh PM.
Indian J Anaesth [serial online] 2010 [cited 2012 Jul 25];54:421-7.

Obstetric patients admitted to an Intensive Care Unit (ICU) present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.
Keywords: Critically ill parturient, haemodynamic, intensive care, obstetrics, pregnancy, sepsis, ventilation
http://www.ijaweb.org/text.asp?2010/54/5/421/71041


http://www.ijaweb.org/temp/IndianJAnaesth545421-5350412_145144.pdf





Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org