Resuscitating the Crashing Pregnant Patient

Emerg Med Clin North Am. 2020 Nov;38(4):903-917. doi: 10.1016/j.emc.2020.06.010.

Abstract

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.

Keywords: Critical care; Maternal resuscitation; Obstetrics; Pregnancy; Respiratory failure; Shock.

Publication types

  • Review

MeSH terms

  • Airway Management
  • Blood Gas Analysis
  • Cesarean Section
  • Contraindications, Drug
  • Critical Illness
  • Emergency Service, Hospital
  • Female
  • Fetal Monitoring
  • Heart Arrest / etiology
  • Heart Arrest / therapy
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Intubation, Intratracheal
  • Maternal-Fetal Exchange
  • Noninvasive Ventilation
  • Placental Circulation
  • Pregnancy / physiology
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / therapy*
  • Respiratory Insufficiency / therapy
  • Resuscitation / methods*
  • Shock / therapy

Substances

  • Hypnotics and Sedatives