Critical Illness in Pregnancy: Part II: Common medical conditions complicating pregnancy and puerperium.

Critical Illness in Pregnancy: Part II: Common medical conditions complicating pregnancy and puerperium. Chest. 2015 May 28; Authors: Guntupalli KK, Karnad DR, Bandi V, Hall N, Belfort M Abstract ABSTRACT: The first of this two part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly affect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in non-pregnant patients including permissive hypercapnia, limits for plateau pressure, prone positioning may not be acceptable especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamionitis, Group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci and clostridium perfringes causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to venous thromboembolism; D-dimer levels have low specificity in pregnancy. A ventilation-perfusion scan is preferred over CT pulmonary angiography in some situations to reduce radiation to the mother's breasts. Low-molecular weight or unfractionated heparins form the mainstay of treatment; vitamin K antagonists, oral Factor Xa inhibitors and direct thrombin inhibitors are not recommended in pregnancy. The physiological hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary ...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research