tailieunhanh - Critical Care Obstetrics part 64

Critical Care Obstetrics part 64 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Fetal Considerations in the Critically Ill Gravida Table Perinatal outcome in 13 reported cases of maternal brain death during pregnancy NA-Not Available SVD- spontaneous vaginal delivery . Gestation age weeks Reference Year Brain death Delivery Indication for delivery Mode of delivery Apgar score at 5min Birth Weight grams Dillon 1 115 1982 25 26 Fetal distress Cesarean 8 850 Dillon 2 1982 18 19 Life support Terminated SVD NA NA Heikkinen 116 1985 21 31 Maternal hypotension Cesarean 7 1 600 Field 117 1988 22 31 Growth impaired Maternal Sepsis Cesarean 8 1 440 Bernstein 118 1989 15 32 Fetal distress Cesarean 9 1 555 Wuermeling 119 1994 14 NA NA SVD NA NA Iriye 120 1995 30 30 Maternal hypotension FHR decelerations Cesarean 8 1 610 Vives 121 1996 27 27 Fetal distress Maternal Hypotension Cesarean 10 1 150 Catanzarite 122 1997 25 29 Chorioamnionitis Cesarean 7 1 315 Lewis 123 1997 25 31 Fetal Lung Maturity Cesarean NA NA Spike 124 1999 16 31 Maternal Hypotension Cesarean 8 1 440 Souza 125 2006 25 28 Oligohydramnios Growth Impaired Cesarean 10 815 Hussein 126 2006 26 28 Oligohydramnios Cesarean NA 1 285 flow. Along with vasopressors to support the maternal blood pressure and organ perfusion the patient should be kept when possible in the lateral recumbent position to maintain uteroplacental blood flow. At the same time care should be exercised to avoid decubitus ulcers. With maternal brain death the thermoregulatory center located in the ventromedian nucleus of the hypothalamus does not function and maternal body temperature cannot be maintained normally. As a result maternal hypothermia is the rule. Maintenance of maternal euthermia is important and usually can be accomplished through the use of warming blankets and the administration of warm inspired humidified air. Maternal pyrexia suggests an infectious process and the need for a thorough septic work-up. Thus infection surveillance for and the treatment of infectious complications is helpful to prolong .