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Journal of Intensive Care Medicine, Vol. 21, No. 5, 278-286 (2006)
DOI: 10.1177/0885066606290390

Critical Care of the Obstetric Patient

Janet M. Shapiro, MD, FCCP

Medical Intensive Care Unit, St. Luke’s Hospital; Columbia University; and Division of Pulmonary and Critical Care Medicine, St. Luke’s and Roosevelt Hospital Center, New York, New York, Jshapiro{at}chpnet.org

The obstetric patient poses exceptional challenges in the intensive care unit. Knowledge of the physiologic changes of pregnancy and specific pregnancy-related disorders is necessary for optimal management. Intensive care unit diagnoses may include preeclampsia, including the HELLP syndrome, pulmonary embolic disease, amniotic fluid embolism, status asthmaticus, respiratory infection, the acute respiratory distress syndrome, and sepsis. The management of mechanical ventilation is based on principles of avoiding lung injury, and hypercapnia may be tolerated even during the pregnancy. When the clinician is faced with the extraordinary instance of cardiopulmonary arrest, perimortem cesarean delivery must be considered to improve the potential for maternal and fetal survival.

Key Words: pregnancy • obstetric • intensive care unit • perimortem cesarean delivery • mechanical ventilation • cardiopulmonary resuscitation • preeclampsia • HELLP syndrome • amniotic fluid embolism • status asthmaticus • pulmonary embolism


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