tailieunhanh - Critical Care Obstetrics part 67

Critical Care Obstetrics part 67 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 | Anesthesia Considerations for the Critically Ill Parturient with Cardiac Disease abuse and severe hemorrhage. The mortality rate is as high as 50 in the event of a myocardial infarction 38 . Delivery should be avoided for 2 weeks postinfarction if at all possible since the mortality rate is extremely high. Early diagnosis consultation with a cardiologist and aggressive therapy are the keys to reducing morbidity and mortality. One study showed that patients with severe postpartum hemorrhage admitted to the ICU had elevated troponin levels and myocardial injury and that tachycardia and hypotension were independent predictors of myocardial ischemia 39 . Spontaneous coronary dissection can occur in the immediate postpartum period and usually involves the left anterior descending coronary artery. Interventions such as coronary stenting and angioplasty have been successful in pregnant patients. Tissue plasminogen activator has been administered for thrombolysis it has a short half-life of about 5 minutes and does not cross the placenta. Anesthetic management Hemodynamic monitoring oxygen supplementation heart rate control with P-blockade assisted vaginal delivery and effective pain control with epidural analgesia are all effective strategies to reduce the myocardial work and oxygen consumption. Epidural anesthesia has been used successfully for labor and delivery in these patients as it reduces the pain and consequent tachycardia. Successful pregnancy outcomes have been reported after myocardial infarction with close monitoring and multidisciplinary management 40 . Pulmonary hypertension Pathophysiology Pulmonary hypertension is a condition characterized by chronic elevation of mean pulmonary artery pressure 25 mmHg at rest or 30 mmHg with exercise and it is associated with a pulmonary capillary wedge pressure lower than 12 mmHg diagnosed by right heart catheterization Table . The World Health Organization has also recently defined pulmonary hypertension to be .