Obstetric Critical Care

Obstetric emergencies are life-threatening for both the mother and the fetus. These emergencies require immediate medical intervention through a multifactorial approach by a team comprising specialists from varied therapeutic areas, including gynecologists, obstetricians, nephrologists, neurologists, and general medicine. In some cases where the delivery is performed, specialized services from neonatologists are also required.

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Diseases and conditions

  • Eclampsia: Preeclampsia is the condition of increased blood pressure in pregnant women with protein in their urine. Eclampsia is a serious but rare complication of preeclampsia. It is characterized by seizures during pregnancy due to high blood pressure.
  • Pregnancy-induced hypertension: Gestational hypertension is an increase in blood pressure in pregnant women without any protein in the urine. The condition usually disappears after delivery. Women with gestational hypertension are at increased risk of developing hypertension in the future.
  • HELLP Syndrome: HELLP Syndrome ( Hemolysis, Elevated Liver Enzymes, and Low Platelet count) is a rare complication of pregnancy characterized by abdominal pain, malaise, blurred vision, nausea and vomiting, edema, and rapid weight gain.
  • Pregnancy-Related Lliver Syndrome: Pregnancy-related liver disorders include pre-eclamptic liver dysfunction, HELLP syndrome, acute fatty liver of pregnancy, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. These liver disorders generally occur during different gestational periods.
  • Posterior Reversible Encephalopathy: Patients with posterior reversible encephalopathy experience seizures, headaches, vision loss, and altered mental status. This condition may be presented after pregnancy due to twin gestation and factor VII deficiency during pregnancy.
  • Postpartum Hemorrhage: It is severe vaginal bleeding that occurs after childbirth. If left untreated, it may lead to maternal death. Other symptoms of postpartum hemorrhage are feeling faint, dizziness, and blurred vision.

Procedures and treatment

  • Coagulation Management: There is a need for anticoagulation therapy during pregnancy and the postpartum period, especially in women with increased risk of deep vein thrombosis, a history of atrial fibrillation, venous thromboembolism, left ventricular dysfunction and fetal loss, and having prosthetic heart valves.
  • Blood pressure control: The aim of blood pressure management in pregnant women is to prevent maternal cardiac and cerebrovascular complications without compromising fetal health. There may be a difference in treatment of pregnant women with gestational hypertension and women with a history of hypertension (before pregnancy).
  • Renal Failure Management: Renal failure management requires obstetrics, general medicine, and nephrology expertise. Renal failure management is done through pharmacotherapy and supportive measures. If these are inadequate, the woman may undergo dialysis. One of the aims of renal failure management in pregnancy is to prolong pregnancy until full-term.
  • Coma and Seizures Control: Seizure complications during pregnancy are rare. However, if they occur, they may lead to maternal acidosis, brain trauma including hemorrhage, and hypoxia. The mainstay of treatment of neurological presentation of severe preeclampsia and eclampsia includes rapid blood pressure reduction, administration of magnesium sulfate, and fetal delivery. Anticonvulsant drugs may also be used for the management of convulsions during pregnancy.