Critical Care Obstetrics

Notes on Contributors ix

Foreword xvii

Preface xix

Part One Basic Critical Care Clinical and Surgical Principles 1

1 Epidemiology of Critical Illness in Pregnancy 3
Cande V. Ananth and John C. Smulian

2 Organizing an Obstetrical Critical Care Unit: Care without Walls 17
Lilly Y. Liu and Leslie Moroz

3 Critical Care Obstetric Nursing 33
Nan H. Troiano and Suzanne McMurtry Baird

4 Pregnancy-Induced Physiologic Alterations 49
Julian N. Robinson and Jeffrey P. Phelan

5 Maternal Blood Gas Physiology 77
Aaron B. Caughey

6 Fluid and Electrolyte Balance 95
William E. Scorza and Sharon Maynard

7 Interventional Radiology in Pregnancy 123
Arsalan Saleem, Sania Javed, Irfan Masood, and Eric M. Walser

8 Fetal Considerations in the Critically Ill Gravida 133
Jeffrey P. Phelan

9 Fetal Effects of Drugs Commonly Used in Critical Care 163
Anthony Kendle and Sarah Gloria Običan

10 Maternal–Fetal Oxygenation 189
Alfred D. Fleming and Marsha Henn

11 Cardiopulmonary Resuscitation (CPR) in Pregnancy 199
Terri–Ann Bennett and Carolyn M. Zelop

12 Neonatal Resuscitation in the Critical Care Setting 209
Jay P. Goldsmith and Gilbert I. Martin

13 Ventilator Management in Critical Illness 233
Luis D. Pacheco and Antonio F. Saad

14 Vascular Access 267
Eryn Hart, Gayle Olson, and Aristides P. Koutrouvelis

15 Nutritional Support 283
Bill Tang, Michael J. Tang, and Jeffrey P. Phelan

16 Acute Kidney Injury and Renal Replacement Therapy 291
Luis D. Pacheco and Chasey I. Omere

17 Cardiopulmonary Bypass 305
Erin G. Sreshta, Tris M. Miller, and Alexis L. McQuitty

18 ECMO in Obstetrics 323
Emily E. Naoum, Amir A. Shamshirsaz, and Luis D. Pacheco

19 Antibiotics, Antivirals, and Antifungals in Critical Care 335
Amir A. Shamshirsaz and Arthur J. Vaught

20 Noninvasive Monitoring in Critical Care 361
Sarah Rae Easter

21 Critical Care Drills in Obstetrics 381
Monica A. Lutgendorf and Shad H. Deering

22 Maternal–Fetal Transport in the High-Risk Pregnancy 397
Joshua A. Makhoul, Albert P. Sarno, Jr., and John C. Smulian

Part Two Acute Emergencies 411

23 Seizure and Status Epilepticus 413
Amir Arain and Michael W. Varner

24 Acute Spinal Cord Injury 423
Lisa R. Wenzel, Angela Vrooman, and Hunter Hammill

25 Severe Acute Asthma 443
Dharani K. Narendra and Nicola A. Hanania

26 Acute Respiratory Distress Syndrome in Pregnancy 455
Dharani K. Narendra, Munish Sharma, David Muigai, and Kalpalatha K. Guntupalli

27 The Acute Abdomen During Pregnancy 475
Ibrahim A. Hammad

28 Acute Pancreatitis 487
Anna S. Leung and Jeffrey P. Phelan

29 Pneumonia During Pregnancy (Bacterial and Viral) 503
M. Ashley Cain and Judette M. Louis

30 Acute Fatty Liver of Pregnancy 519
Ibrahim A. Hammad and T. Flint Porter

31 Disseminated Intravascular Coagulation 527
Martina Burn, Hillary Hosier, Nazli Hossain, and Michael J. Paidas

32 Endocrine Emergencies 541
Mary C. Tolcher, Heather S. Hoff, Kjersti M. Aagaard, and Jeffrey P. Phelan

33 Acute Psychiatric Conditions in Pregnancy: Critical Care Obstetrics 555
Kelly B. Zafman and Adina R. Kern-Goldberger

34 Diabetic Ketoacidosis 571
Mark A. Curran

Part Three Shock in Pregnancy 585

35 Hypovolemic Shock 587
Jerasimos Ballas and Scott Roberts

36 Blood Component Therapy and Massive Transfusion 603
Shiu-Ki R. Hui, Kjersti M. Aagaard, and Jun Teruya

37 Etiology and Management of Hemorrhage (Includes Accreta) 627
Irene A. Stafford, Karin A. Fox, Michael A. Belfort, and Gary A. Dildy

38 Septic Shock 665
Sonya S. Abdel-Razeq

39 Cardiogenic Shock 697
Martha W. F. Rac and Mary C. Tolcher

40 Anaphylactic Shock in Pregnancy 707
Richard Burwick

41 Amniotic Fluid Embolism 719
Gary A. Dildy, Michael A. Belfort, and Steven L. Clark

Part Four Medical/Surgical Management 737

42 Pregnancy-Related Stroke 739
Loralei L. Thornburg, Jamil ElFarra, and James N. Martin, Jr.

43 Cardiac Disease and Pregnancy 775
Abby Frederickson, Jordan D. Awerbach, Roxann Rokey, Michael A. Belfort, and Wayne J. Franklin

44 Anesthesia Considerations for the Critically Ill Gravida with Cardiac Disease 813
Yi Deng, Sanjna Tripathy, Lisa Mouzi Wofford, Vibha Mahendra, and Shoba Murugan

45 Thromboembolic Disease 831
Martha Pritchett Mims and Arthur J. Vaught

46 Pulmonary Hypertension in Pregnancy 849
Mohammad Zaidan and Alexander G. Duarte

47 Sickle Cell Disease and Pregnancy 869
Mark M. Udden and Iberia Romina Sosa

48 Thrombotic Thrombocytopenic Purpura, Hemolytic–Uremic Syndrome, and HELLP 883
Kelty R. Baker

49 Complications of Preeclampsia 901
Mary C. Tolcher and Kjersti M. Aagaard

50 Systemic Lupus Erythematosus and Antiphospholipid Syndrome 939
Fawzi Saoud and Maged M. Costantine

51 Trauma in Pregnancy 959
Robert Rossi, Alfredo F. Gei, Arthur J. Vaught, and James W. Van Hook

52 Thermal and Electrical Injury 987
Cornelia R. Graves

53 Overdose, Poisoning, and Envenomation during Pregnancy 995
Alfredo F. Gei, Victor R. Suarez, Arthur J. Vaught, and James W. Van Hook

54 The Organ Transplant Patient in the Obstetric Critical Care Setting 1053
Calla Holmgren and James Scott

55 Fetal Surgery Procedures and Associated Maternal Complications 1065
Eyal Krispin, Amir A. Shamshirsaz, Ahmed A. Nass, and Alireza A. Shamshirsaz

56 Cancer in the Pregnant Patient 1075
Kristin Bixel, Kenneth H. Kim, and David M. O’Malley

57 Mass Casualties and the Obstetrical Patient 1093
Lisa M. Foglia and Peter E. Nielson

58 Biological, Chemical, and Radiological Exposures in Pregnancy 1099
Lisa M. Foglia and Peter E. Nielson

Part Five Ethical and Legal Considerations 1109

59 Ethics in the Obstetric Critical Care Setting 1111
Fidelma B. Rigby

60 Medical–Legal Considerations in Critical Care Obstetrics 1137
Jeffrey P. Phelan

Index 1161

For the first time in decades, maternal mortality rates are climbing in the United States. Factors including lack of access to prenatal care, un- or underinsured populations, rising rates of cardiovascular disease, and more combine to make pregnancy and childbirth more dangerous prospects. In this environment, the study of critical care obstetrics has never been more essential.

Critical Care Obstetrics, Seventh Edition a fully updated guide to the medical management of serious conditions in pregnancy and childbirth. Beginning with basic principles, it surveys the potential serious complications occurring in pregnancy and delivery and the techniques and procedures for maximizing patient outcomes for both pregnant people and fetuses. This clear, accessible text promises to continue the essential work of earlier editions.

Readers of the seventh edition of Critical Care Obstetrics will also find:

• Detailed protocols for implementing life-saving treatments in emergencies
• New chapters on topics including ECMO, antibiotics, and pneumonia
• Authorship by internationally renowned experts in emergency obstetrics

Critical Care Obstetrics is ideal for working clinical obstetricians and for trainees in obstetrics and gynecology.

Luis D. Pacheco, MD, is Professor in the Department of Obstetrics and Gynecology and Anesthesiology and Division Chief of Obstetrics and Maternal Fetal Medicine, University of Texas Medical Branch, Galveston. He is board certified in critical care medicine.

Jeffrey P. Phelan, MD, is a Maternal-Fetal Medicine specialist and Obstetrician-Gynecologist in West Covina, California, and holds positions at multiple area hospitals. He has over 35 years of clinical experience in the practice of Maternal-Fetal Medicine and in the area of Critical Care OB. Of note, Dr. Phelan has served as an editor and author on all prior editions of Critical Care OB.

Torre L. Halscott MD, MS, is an Assistant Professor in the Department of Obstetrics and Gynecology and medical director of the Nelson Obsterical Clinic. Johns Hopkins University School of Medicine. He is board certified in critical care medicine.

Leslie A. Moroz MD, MS, is an Assistant Professor in the Department of Obstetrics and Gynecology, Yale School of Medicine. She is board certified in critical care medicine.

Arthur J. Vaught, MD, is an Associate Professor in the Department of Obstetrics and Gynecology and Surgery. He is the Director of Labor and Delivery and of the Advanced Obstetric Surgery Center. Johns Hopkins University, Baltimore, Maryland. He is board certified in critical care medicine.

Antonio F. Saad, Professor at the Department of Obstetrics and Gynecology Director of Perinatal Research Unit And MFM Fellowship, Inova Health, Inova Fairfax Medical Campus.

Amir A. Shamshirsaz, MD, is an Assistant Professor in the Department of Obstetrics and Gynecology and Medicine, Texas Children’s Hospital/Pavillion for Women and Baylor St. Luke’s Medical Center. He is board certified in critical care medicine.