Principles of Critical Care in Obstetrics: Volume II

360 Pages·2016·12.01 MB·English

by  Alpesh Gandhi

Principles of
Critical Care in
Obstetrics
Volume II
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) N idhi Gupta
Neharika Malhotra Bora
Editors
Principles of Critical
Care in Obstetrics
Volume II
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 978-81-322-2684-0 ISBN 978-81-322-2686-4 (eBook)
DOI 10.1007/978-81-322-2686-4
Library of Congress Control Number: 2015960281
Springer New Delhi Heidelberg New York Dordrecht London
© Springer India 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specifi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
T he publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made.
Printed on acid-free paper
Springer (India) Pvt. Ltd. is part of Science+Business Media (www.springer.com)
Contents
Part I Respiratory Emergencies During Pregnancy
1 Bronchial Asthma in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Uma Wankhede and Abhijeet Wadate
2 Acute Respiratory Distress Syndrome (ARDS) in Pregnancy . . . 9
Revathy Janakiram , Krithika Meenakshi , and J. Madurai
3 Pregnancy with H1N1 Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . 15
J. B. Sharma and Manisha Yadav
4 Pregnancy with Chicken Pox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Prakash K. Mehta
Part II Medical Disorders and Organ System Dysfunctions
Requiring Critical Care
5 Cardiac Diseases in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Hemant Deshpande and Sonali Deshpande
6 Acute Renal Failure (Acute Kidney Injury) in Pregnancy . . . . . 45
Gita Arjun and M. Sivalingam
7 Acute Fatty Liver of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Asha Reddy
8 Fulminant Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Suchitra N. Pandit and Deepali P. Kale
9 Acute Pancreatitis in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Sunita Ghike and Madhuri Gawande
10 Complicated Malaria and Dengue During Pregnancy . . . . . . . . 81
Haresh U. Doshi
11 Neurological Emergencies During Pregnancy . . . . . . . . . . . . . . . 87
Anuradha Ridhorkar
Part III Endocrinal Crisis
12 Diabetic Ketoacidosis in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . 95
Vinita Das
v
vi Contents
13 Thyroid Dysfunction and Its Emergencies in Pregnancy . . . . . 101
Nalini I. Anand and Amita A. Gandhi
14 Other Endocrine Emergencies in Pregnancy . . . . . . . . . . . . . . . 127
Anita Singh and Shipra Singh
Part IV Special Conditions Requiring Critical Care
15 Severe Anemia in Critically Ill Obstetric Patients . . . . . . . . . . . 139
Kavita N. Singh and Jitendra Bhargava
16 Management of Sickle Cell Crisis in Pregnancy . . . . . . . . . . . . 145
Sadhana Gupta and Hema J. Shobhane
17 HIV in Critical Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 55
Atul Munshi and Sujal Munshi
18 Antiphospholipid Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Mala Arora
19 Systemic Lupus Erythematosus and Pregnancy . . . . . . . . . . . . 171
Hiralal Konar and Picklu Chaudhuri
20 DVT and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Vijayalakshmi G. Pillai
21 Gestational Trophoblastic Disease . . . . . . . . . . . . . . . . . . . . . . . . 197
P. K. Sekharan
22 Peripartum Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Vidya A. Thobbi and Abhijit V. Kulkarni
23 Cerebral Venous Thrombosis in Pregnancy . . . . . . . . . . . . . . . . 225
Shobha N. Gudi
24 Post-operative Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Radhakrishna Nayak
25 Trauma and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Anuradha Khanna , Uma Pandey , and Pooja Singh
26 Burns in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Reeti Mehra and Sanjay Gupta
27 Poisoning in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Pushpa Junghare and Sayali Jahagirdar
28 Electric Injury in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Alok Sharnma and Rohini Rao
29 Acute Psychiatric Crisis in Obstetrics . . . . . . . . . . . . . . . . . . . . . 283
Neema Acharya
30 Cancer in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
M. Jayaraman Nambiar and Theincherry Rema
Contents vii
31 Life-Threatening Complications of MTP/Abortion . . . . . . . . . . 295
Shrinivas Gadappa and Rajendrasing Pardeshi
32 Ovarian Hyperstimulation Syndrome and Pregnancy . . . . . . . 309
Rishma Pai , Hrishikesh Pai , Nandita Palshtetar ,
and Pritimala Gangurde
33 Obesity in Obstetric Intensive Care Patient . . . . . . . . . . . . . . . . 317
Narendra Malhotra , Esha Sharma , Jaideep Malhotra ,
and Neharika Malhotra Bora
34 Drug-Induced Serious Maternal and Fetal Complications
in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Rajendrasing Pardeshi and Ajay Mane
35 Anesthesia and Pain Relief in Critically Ill
Obstetric Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Alka Saraswat
36 Transport of the Critically Ill Obstetric Patient . . . . . . . . . . . . 337
Lila Vyas and Rekha Menghani
Part V Critically Ill Foetus
37 Twin-to-Twin Transfusion Syndrome:
As an Obstetric Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Shah Aditi and Radhakrishnan Prathima
38 Diagnosis and Management of Fetal Anemia . . . . . . . . . . . . . . . 359
S. Suresh
39 Neonatal Resuscitation “When Baby Does Not Cry” . . . . . . . . 367
Shruti Sudhir Jadhav , Sushma Malik , and Reena Jatin Wani
Part I
Respiratory Emergencies
During Pregnancy
1
Bronchial Asthma in Pregnancy
Uma Wankhede and Abhijeet Wadate
The majority of women with asthma have normal Effect of Pregnancy on Asthma
pregnancies and the risk of complications is small
in those with well-controlled asthma. Maternal hyperventilation occurs from increasing
Asthma is estimated to occur in about 4 % of concentration of progesterone without a corre-
pregnancies, typically occurring as a pre-existing sponding change in respiratory rate. Pregnancy has
comorbidity, although some cases of asthma may variable effects on asthma. About 28 % of pregnant
initially present during pregnancy. The overall asthmatics improve, 33 % remain unchanged and
management goals of asthma in pregnancy are 35 % deteriorate usually between 24 and 36 weeks
effective management of symptoms to avoid foe- of gestation. Asthma symptoms improve during the
tal hypoxia, whilst at the same time minimising last 4 weeks (37–40 weeks) [3 ].
any drug-related risks to the foetus [1 ]. D uring labour and delivery, only 10 % of asth-
The diagnosis of asthma is based on history, matics report symptoms and only half of those
physical examinations and pulmonary function require treatment. During postpartum period, the
tests. The common symptoms are episodic severity of asthma reverts to its pre-pregnancy
breathlessness, wheezing cough and chest tight- level. The conclusions of a meta-analysis of 14
ness. Episodic symptoms after incidental aller- studies are in agreement with the commonly
gen exposure, seasonal variability of symptoms quoted generalisation that during pregnancy
and a positive family history of asthma are also about one third of asthma patients experience an
helpful diagnostic guides. The most usual physi- improvement in their asthma, one third experi-
cal fi nding is wheezing on auscultation. ence a worsening of symptoms and one third
Pulmonary function tests like PEFR measure- remain the same. There is also some evidence
ment with the help of a simple tool called peak that the course of asthma is similar in successive
fl ow meter can also aid in the diagnosis. The spi- pregnancies.
rometric evaluation of asthma in pregnant patients Studies suggest that 11–18 % of pregnant
is similar to that in non-pregnant patients. FVC, women with asthma will have at least one emer-
forced expiratory volume in 1 s into (FEV1), gency department visit for acute asthma, and of
FEV1/FVC ratio and peak expiratory fl ow are these 62 % will require hospitalisation. Severe
stable to slightly increased in pregnancy [2 ]. asthma is more likely to worsen during preg-
nancy than mild asthma, but some patients with
U. Wankhede (*) • A. Wadate very severe asthma may experience improve-
Associate Professor, B.J. Government Medical ment, whilst symptoms may deteriorate in some
College , Pune , India
patients with mild asthma.
e-mail: [email protected]
© Springer India 2016 3
A. Gandhi et al. (eds.), Principles of Critical Care in Obstetrics: Volume II,
DOI 10.1007/978-81-322-2686-4_1