Vasquez Daniela N, Plante Lauren, Basualdo María N, Plotnikow Gustavo G
Intensive Care Unit, Sanatorio Anchorena, Autonomous City of Buenos Aires, Argentina.
Departments of Anesthesiology and Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Semin Respir Crit Care Med. 2017 Apr;38(2):218-234. doi: 10.1055/s-0037-1600910. Epub 2017 May 22.
Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.
妊娠和产后患者对重症监护医生来说是一项挑战,因为要同时照顾两名患者,而且还需要处理一些特定的产科疾病,这些疾病在正规的重症监护培训中并未全面涵盖。妊娠还会改变生理标准,以至于重症监护医生可能无法识别妊娠期间异常的数值,或者错误地将孕妇正常范围内的数值判定为异常。在本文中,我们将回顾妊娠/产后患者入住重症监护病房最常见的产科病因(妊娠高血压疾病、产科出血和产科败血症)及其诊断标准、临床表现和推荐治疗方法。我们还将介绍一些特定的、但不太常见的产科疾病,如妊娠急性脂肪肝、围产期心肌病和羊水栓塞。我们的主要目标是提高这类患者的护理质量。