Principles of Critical Care in Obstetrics: Volume I

358 Pages·2016·17.16 MB·English

by  Alpesh Gandhi

Principles of
Critical Care in
Obstetrics
Volume I
Alpesh Gandhi
Narendra Malhotra
Jaideep Malhotra
Nidhi Gupta
Neharika Malhotra Bora
Editors
123
Principles of Critical Care in Obstetrics

Alpesh Gandhi (cid:129) Narendra Malhotra
Jaideep Malhotra (cid:129) Nidhi Gupta
Neharika Malhotra Bora
Editors
Principles of Critical
Care in Obstetrics
Volume I
Editors
Alpesh Gandhi
Arihant Women’s Hospital
Ahmedabad
Gujarat
India
Narendra Malhotra
Global Rainbow Healthcare
Agra
India
Jaideep Malhotra
Art Rainbow-IVF
Agra
India
Nidhi Gupta
SN Medical College
Obstetrics and Gynecology
Agra
India
Neharika Malhotra Bora
Bharti Vidya Peethmedical College
Pune
India
ISBN 978-81-322-2690-1 ISBN 978-81-322-2692-5 (eBook)
DOI 10.1007/978-81-322-2692-5
Library of Congress Control Number: 2015960281
Springer New Delhi Heidelberg New York Dordrecht London
© Springer India 2016
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Contents
Part I Introduction to Critical Care
1 Epidemiology of Critical Illness in Obstetrics. . . . . . . . . . . . . . 3
Shikha Singh and Narendra Malhotra
2 Pregnancy-Induced Alterations in Physiology
and Laboratory Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
C. N. Purandare , Madhuri Patel , and Surekha Tayade
3 Ethics in the Setting Up of Obstetric HDU and ICU . . . . . . . . 15
K. Muhunthan and Sabaratnam Arulkumaran
4 Organisation and Role of Critical Care Units:
Obstetric HDU/ICU. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Alpesh Gandhi
5 Cardiopulmonary Resuscitation in the Pregnant
Woman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Amita Gandhi and Alpesh Gandhi
Part II Procedures and Monitoring in the HDU/ICU Unit
6 Role of Imaging in Noninvasive Monitoring
in Obstetric Intensive Care Unit. . . . . . . . . . . . . . . . . . . . . . . . . 51
Santosh Singhal , Rishabh Bora , Narendra Malhotra ,
and Jaideep Malhotra
7 Basic Hemodynamic and Cardiac Monitoring
in Obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Pratima Mittal , Jyotsna Suri , and Pradeep K. Verma
8 Respiratory Monitoring and Blood Gas Physiology. . . . . . . . . 69
Shivakumar Iyer and Jignesh Shah
9 Obstetric Monitoring in Critically Ill Pregnant Women . . . . . 81
Narendra Malhotra , Anupama Suwal , Jaideep Malhotra ,
and Neharika Malhotra Bora
10 Fetal Surveillance in Critically Ill Obstetric Patient . . . . . . . . 85
Neharika Malhotra , Rishabh Bora , and Keshav Malhotra
v
vi Contents
11 Infection Prevention and Control Policy
in Obstetric HDU and ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Jayam Kannan
12 Transfusion of Blood Components and Derivatives
in the Obstetric Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Lakhbir Dhaliwal and Rakhi Rai
13 Fluid and Electrolyte Balance in Critically Ill
Obstetric Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Ruchika Garg and Rekha Rani
14 Mechanical Ventilation in Critically Ill
Obstetric Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Mohammed Azam Danish
15 Nutrition in the Critically Ill Obstetric Patient. . . . . . . . . . . . . 143
Kamini A. Rao and Smitha Avula
Part III Clinical Shock Syndromes
16 Post-partum Haemorrhage: Prevention, Medical
and Mechanical Methods of Management. . . . . . . . . . . . . . . . . 153
Ruchika Garg
17 Conservative and Nonconservative Surgical
Management of Postpartum Hemorrhage. . . . . . . . . . . . . . . . . 159
V. P. Paily and Vasanthi Jayaraj
18 The Lower Segment of Uterus – A Critical Area
in Childbirth and Resulting Trauma . . . . . . . . . . . . . . . . . . . . 175
Ajit C. Rawal
19 Ruptured Ectopic Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Abdul Vahab and P. Mumtaz
20 Cardiogenic Shock in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 207
Sourya Acharya
21 The Recognition and Management of Maternal Sepsis . . . . . . 215
Karen Orr , Damien Hughes , Claire Jamison ,
and Paul Fogarty
22 Anaphylactic Shock in a Pregnant Woman. . . . . . . . . . . . . . . . 237
Veena Agrawal
23 Sudden Obstetric Collapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Lisa M. Nathan and Asha Rijhsinghani
24 Disseminated Intravascular Coagulation (DIC)
and Thrombocytopenia in Pregnancy . . . . . . . . . . . . . . . . . . . . 259
Alka Saraswat , Jaideep Malhotra , Narendra Malhotra ,
and Neharika Malhotra Bora
Contents vii
Part IV HDP and It’s Problems Requiring Critical Care
25 Hypertensive Crisis in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 271
Girija Wagh
26 Eclampsia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Sanjay Gupte
27 Antepartum Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Nidhi Gupta
28 HELLP Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
P. K. Shah , Mayoor Daigavane , and Natasha DSouza
Part V Critical Conditions in LR/OT
29 Amniotic Fluid Embolism and Pulmonary Embolism. . . . . . . 313
Nidhi Patel and Ajesh Desai
30 Management of Critical Cord Accidents. . . . . . . . . . . . . . . . . . 327
A. K. Debdas
31 Acute Inversion of the Uterus. . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Gokul Chandra Das and Gitanjali Deka
32 Rupture of the Gravid Uterus. . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Ashis Kumar Mukhopadhyay
33 Shoulder Dystocia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Madhu Nagpal
34 Diffi culty in the Delivery of a Baby During LSCS . . . . . . . . . . 355
Parul J. Kotdawala and Munjal J. Pandya
Part I
Introduction to Critical Care
1
Epidemiology of Critical Illness
in Obstetrics
Shikha Singh and Narendra Malhotra
Critical illness in pregnancy as a morbidity out- that have the potential for serious morbidity, dis-
come is diffi cult to defi ne and therefore diffi cult to ability, and mortality.
measure and study precisely. As stated by Harmer, The successful epidemiologic evaluation of any
“Death represents the tip of the morbidity iceberg, particular disease or condition has several prereq-
the size of which is unknown” [1 ]. The stage at uisites. Two of the most important prerequisites
which any condition becomes severe enough to be are that the condition should be accurately defi ned
classifi ed as a critical illness has not been clearly and that there should be measurable outcomes of
defi ned. However, it may be helpful to consider interest. Another requirement is that these must be
critical illness as impending, developing, or estab- some systematic way of data collection or surveil-
lished signifi cant organ dysfunction, which may lance that will allow the measurement of the out-
lead to long-term morbidity or death. This allows comes of interest and associated risk factors.
some fl exibility in the characterization of disease Historically, surveillance of pregnancy-related
severity since it recognizes condition that can critical illness has focused on the well-defi ned
deteriorate rather quickly in pregnancy. outcome of maternal mortality in order to iden-
I t has been suggested that most women suffer- tify illnesses or conditions that might have led to
ing a critical illness in pregnancy are likely to be maternal death. Maternal mortality data collec-
in an intensive care unit. These cases have been tion is well established in many places, but spe-
described by some as “near-miss” mortality cifi c surveillance systems that track severe
cases. There are many conditions in pregnancy complications of pregnancy not associated with
that occur frequently and require special medical maternal mortality are rare. Examination of com-
care, but do not actually become critical illness. plicating conditions associated with maternal
Most women with these complications have rela- hospitalization can provide information on the
tively uneventful pregnancies that result in good types of conditions requiring hospitalized case.
outcome. Nevertheless, each of these conditions
can be associated with signifi cant complications
ICU Admissions and Maternal
Mortality
S. Singh (*)
Department of Obstetrics and Gynaecology ,
Evaluation of obstetric admissions to intensive
S.N. Medical College , Agra , India
e-mail: [email protected] care units (ICUs) may be one of the best ways to
approach surveillance of critical illness in preg-
N. Malhotra , MD
Director , Rainbow Hospitals , Agra , India nancy. Unfortunately, there is no publicly available
© Springer India 2016 3
A. Gandhi et al. (eds.), Principles of Critical Care in Obstetrics: Volume I,
DOI 10.1007/978-81-322-2692-5_1