Principles of Critical Care in Obstetrics: Volume I PDF
Preview Principles of Critical Care in Obstetrics: Volume I
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 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. The 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 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
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