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Chest. 2015 Nov;148(5):1333-1345. doi: 10.1378/chest.14-2365.

Critical Illness in Pregnancy: Part II: Common Medical Conditions Complicating Pregnancy and Puerperium.

Author information

1
Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX. Electronic address: kkg@bcm.edu.
2
Department of Critical Care, Jupiter Hospital, Thane, India.
3
Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX.
4
Department of Medicine, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Texas Children's Hospital Pavilion for Women, Houston, TX.
5
Department of Medicine, the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Surgery, Baylor College of Medicine, Houston, TX; Department of Anesthesiology, Baylor College of Medicine, Houston, TX; Department of Obstetrics and Gynecology, Texas Children's Hospital Pavilion for Women, Houston, TX.

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 nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to VTE; 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 physiologic hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary edema or arrhythmias in mitral stenosis, heart failure in pulmonary hypertension or aortic stenosis, aortic dissection in Marfan syndrome, or valve thrombosis in mechanical heart valves. Common neurologic problems in pregnancy include seizures, altered mental status, visual symptoms, and strokes. Other common conditions discussed are aspiration of gastric contents, OSA, thyroid disorders, diabetic ketoacidosis, and cardiopulmonary arrest in pregnancy. Studies confined to pregnant women are available for only a few of these conditions. We have, therefore, reviewed pregnancy-specific adjustments in the management of these disorders.

PMID:
26020727
DOI:
10.1378/chest.14-2365
[Indexed for MEDLINE]

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