tailieunhanh - Critical Care Obstetrics part 44

Critical Care Obstetrics part 44 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 | Thrombotic Thrombocytopenic Purpura Hemolytic-Uremic Syndrome and HELLP CI to mean interval hours to delivery 41 15 versus 15 p in favor of women randomised to dexamethasone. There were no significant differences in perinatal mortality or morbidity due to respiratory distress syndrome need for ventilatory support intracerebral hemorrhage necrotizing enterocolitis and a 5-min Apgar less than 7. The mean birthweight was significantly greater in the group allocated to dexamethasone WMD 95 CI . These authors concluded that based on these five studies there was insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and perinatal mortality or major maternal and perinatal morbidity. Antepartum plasma exchanges do not arrest or reverse HELLP syndrome however peripartum exchanges may minimize hemorrhage and morbidity. Plasma exchanges should probably be employed in women who fail to improve within 72-96 hours after delivery. This is a subgroup of about 5 of HELLP patients who are usually either nulliparous or younger than 20 years of age . Liver transplantation may eventually be necessary in cases complicated by large destructive hematomas or total hepatic necrosis 163 Although the condition of most HELLP patients stabilizes within 24-48 hours following delivery death occurs in 3-5 . Maternal mortality rates as high as 25 were reported prior to 1980 usually because of cerebral hemorrhage cardiopulmonary arrest DIC adult respiratory distress syndrome or hypoxic ischemic encephalopathy 139 . Other complications can include infection abruptio placentae postpartum hemorrhage intraabdominal bleeding pulmonary edema retinal detachment postictal cortical blindness hypoglycemic coma and subcapsular liver hematoma with subsequent rupture mortality about 50 140 164 . Patients with the latter complication may complain of right-sided shoulder pain and may develop shock with ascites and or