Updates in Intensive Care of OBGY Patients

This book presents the updated management of acute and critically ill obstetric and gynecological patients. It describes patients' care with pregnancy-induced medical disorders, comorbidities, and gynecological (OBGY) conditions requiring acute and intensive care support therapy. This book will guide early diagnosis and speedy management of life-threatening conditions. Chapters provide a comprehensive and systemic approach in an easy-to-understand format. Along with diseases and comorbidities of pregnancy, acute illness and its management caused by in vitro fertilization (IVF) are focused on, and a dedicated chapter about COVID-19 infection in obstetric patients is provided. Updates in Intensive Care of OBGY Patients will support intensivists, obstetricians, gynecologists, acute care physicians, and surgeons. Residents, fellows, specialists, and other junior medical staff working in intensive care units will also value this source. It will also help to broaden the understanding of nurses and paramedical staff in intensive care therapy. Preface Contents Peripartum Cardiomyopathy: An Update 1 Introduction 2 Epidemiology 3 Definition 4 Risk Factors 5 Pathophysiology 6 Diagnosis 7 Treatment 8 Morbidity and Mortality 9 Re-pregnancy in PPCM 10 Conclusion References Microangiopathic Hemolytic Anemia of Pregnancy: Facts and Figures 1 Introduction 2 Epidemiology 3 Etiopathology 4 Diagnosis 5 HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelets) 6 Complete 7 Clinical Presentation Criteria 8 Thrombotic Thrombocytopenic Purpura 9 Immune-Mediated Thrombotic Thrombocytopenic Purpura (TTP) 10 Triggering Factors 11 Management TTP Presenting in Pregnancy 12 Management Pregnancy in Known TTP 13 CM HUS—Complement-Mediated Hemolytic Uremic Syndrome 14 Management 15 Pregnancy as a Trigger 16 Management of CM HUS in Pregnancy 17 Management of Pregnancy in Known CM HUS 18 Acute Fatty Liver of Pregnancy (AFLP) 19 Management 20 Conclusion References Sepsis and Septic Shock in the Peripartum Period 1 Introduction 2 Epidemiology 3 Risk Factors 4 Etiology 5 Pathophysiology 6 Systemic Effects of Sepsis 7 Management 7.1 Diagnostic Challenge 7.2 Early Recognition 7.3 Initial Investigations 7.4 Initial Management 8 Prevention 9 Conclusion References Preeclampsia: Updates in Diagnosis and Management—ICU Perspective 1 Introduction 2 Pathophysiology 3 Management of Preeclampsia 4 Central Nervous System 4.1 Eclampsia 4.2 Stroke 4.3 Posterior Reversible Encephalopathy Syndrome 4.4 Reversible Cerebral Vasoconstriction Syndrome 5 Renal System 5.1 Acute Kidney Injury 5.2 Nephrotic Syndrome 5.3 Specific Considerations in the Management of Patients with Renal Dysfunction in Preeclampsia 5.4 When to Consider Delivery in Renal Impairment? 5.5 Managing Hypertension and Eclampsia Prevention in Renal Impairment 5.6 Fluid Management 5.7 Renal Replacement Therapy 5.8 Delivery 5.9 Mode of Delivery 6 Postpartum and Beyond 7 Levels of Care in Severe Preeclampsia 8 Pulmonary Edema 8.1 The Management of Hypertensive Acute Pulmonary Edema in Pregnancy 8.2 Peripartum Cardiomyopathy (PPCM) and Preeclampsia 8.3 Management of PPCM 9 Conclusion References Peripartum Pulmonary Embolism: From Diagnoses to Management 1 Background 2 Epidemiology 3 Risk Factors 4 Pathophysiology 4.1 Venous Stasis 4.2 Vascular Injury and Dysfunction 4.3 Hypercoagulability 5 Diagnosis 5.1 Chest X-Ray 5.2 Bilateral Lower Limb Sonography 5.3 Ventilation-Perfusion Scan 5.4 Single Photon Emission CT Ventilation (SPECT VQ) 5.5 Digital Subtraction Angiography 5.6 Computed Tomographic Pulmonary Angiography (CTPA) 5.7 Magnetic Resonance Pulmonary Angiography (MRPA) 5.8 Echocardiography 6 Treatment 7 Prevention 8 Conclusion References Peripartum Hemorrhage: Recent Updates in Management 1 Introduction 2 Definitions and Classification 3 California Maternal Quality Care Collaborative Staging System 4 Risk Factors and Causes of Peripartum Hemorrhage 5 Diagnosis/Recognition 6 Investigations 7 Prevention/Potential Deterioration 8 Management of Peripartum Hemorrhage 8.1 Initial/General Approaches 9 Antepartum Period 9.1 Placental Abruption 9.2 Placenta Previa 9.3 Placenta Accreta Spectrum 9.4 Uterine Rupture 9.5 Vasa Previa 9.6 Incidental Causes 10 Postpartum Hemorrhage 11 Monitoring 12 Current Trends and Future Direction in the Management of PPH 12.1 Tranexamic Acid 12.2 Identification of Factors in Event Recurrence 12.3 Translational Pharmacology 13 Conclusion References Trauma in Pregnancy-Requiring Intensive Care 1 Introduction 2 Epidemiology 3 Physiologic Changes During Pregnancy 3.1 Respiratory System 3.1.1 Special Considerations 3.2 Cardiovascular System 3.2.1 Special Considerations 3.3 Hematology and Coagulation 3.4 Gastrointestinal System 3.5 Kidneys and Renal Tract 4 Management of the Pregnant Trauma Victim 4.1 Prehospital Care 4.2 Primary Survey with Simultaneous Resuscitation 4.2.1 Airway and Breathing 4.2.2 Circulation 4.2.3 Disability 4.2.4 Exposure 4.2.5 Fetus 4.3 Secondary Survey 4.3.1 Isoimmunization of the Mother in Rh-Negative Woman 4.4 Adjuncts to the Secondary Survey 4.4.1 Perimortem Cesarean Section 4.5 Intensive Care Management 4.6 Fetal Monitoring in Intensive Care Unit 4.7 ICU Care Issues 5 Outcome of Pregnancy in Trauma 6 Summary References Eclampsia: An Update 1 Introduction 2 Epidemiology 3 Definitions 4 Pathogenesis 5 Risk Factors 6 Presentation and Diagnosis 7 Management 7.1 Maintenance Oxygenation and Protection from Injuries 7.2 Hypertension Treatment and Stabilization 7.3 Anticonvulsant Medication (Fig. 1) 7.3.1 Persistent Seizure Activity 7.3.2 Prevention of Recurrent Seizures Magnesium Sulfate Prophylaxis 7.4 Dosing and Toxicity 7.4.1 Loading Dose 7.4.2 Maintenance Dose 7.4.3 Therapeutic Magnesium Level 7.5 Magnesium Sulfate Toxicity and Side Effects 7.6 Recurrent Seizures Management 8 Fetal Resuscitation 9 Timing and Route of Fetus Delivery 10 Anesthesia 11 Postpartum Care 11.1 Magnesium Sulfate Therapy Duration 11.2 Treatment of Hypertension in Postpartum 11.3 Neurological Follow-up 12 Complications 12.1 Maternal 12.2 Fetal and Neonatal 13 Eclampsia Prevention 14 Conclusion References Intensive Care Therapy Requirement in the Management of the Gynecological and Obstetric Patients 1 Introduction 2 Epidemiology 3 Anatomical and Physiological Changes During Pregnancy 3.1 Indication for Intensive Care Therapy 4 Assessment 5 ICU (Intensive Care Unit) Management of Gynecological and Obstetric (OBGY) Patients 5.1 General Care 5.2 Initial Management 5.3 Specific Condition 5.3.1 Obstetrical Peripartum Hemorrhage 5.3.2 Sepsis 5.3.3 Hypertensive Disorders of Pregnancy 5.3.4 Amniotic Fluid Embolism 5.3.5 Local Anesthetic Toxicity 6 Conclusion References Anesthesia-Related Complications in Obstetrics and Gynecology 1 Introduction 2 Post-dural Puncture Headache (PDPH) 3 Inadequate Block for Cesarean Section 4 Subdural Injection 5 High Spinal/Total Spinal 6 Local Anesthetic Systemic Toxicity 7 Neurological Complications 8 Injury to the Spinal Cord, Cauda Equina 8.1 Prevention and Management 9 Hemorrhage 9.1 Spinal Epidural Hematoma (SEH) 9.2 Intracranial Hemorrhage 10 Infective Complications 10.1 Spinal Epidural Abscess 11 Side Effects 12 General Anesthesia Complications 13 Accidental Awareness Under General Anesthesia 14 Aspiration 15 Cardiac Arrest in Pregnancy 16 Trauma in Pregnancy 17 Hemorrhage 18 Embolism 19 Disseminated Intravascular Coagulation 20 Eclampsia 21 Cardiac Diseases in Pregnancy 22 Conclusion References Ovarian Hyperstimulation Syndrome 1 Definition 2 History 3 Incidence 4 Pathogenesis 5 Natural Cycle OHSS 6 Pathophysiology 6.1 Potential Biochemical Mediators 7 Immunological Aspects 8 Genetic Aspects of OHSS 9 Primary Risk Factors 9.1 Before Treatment 9.2 At Risk During Stimulation of OHSS 9.3 Other Risk Factors 10 Forms, Classification, and Grading Schemes 10.1 Early ( 10 Days After Ovulation Triggering Injection of HCG) 11 Clinical Classification 11.1 Mild OHSS 11.2 Moderate OHSS 11.3 Severe OHSS 12 Clinical Manifestations of OHSS 12.1 Mild OHSS 12.2 Severe OHSS 12.3 Critical OHSS 12.3.1 Circulatory Effects 12.3.2 Thrombosis 12.3.3 Respiratory 12.3.4 Renal 12.3.5 Hepatic 13 Clinical Manifestation of OHSS in Patients Not Receiving Ovulation-Inducing Drugs 14 OHSS in Patients Related to Intake of Ovulation-Inducing Drugs (Iatrogenic OHSS) 14.1 OHSS In Vitro Fertilization Programs 14.2 Patients at Risk of Iatrogenic OHSS 14.3 Clinical Manifestations of Iatrogenic OHSS 14.4 Clinical Manifestations of Mild Iatrogenic OHSS 14.5 Clinical Manifestations of Severe Iatrogenic OHSS 14.6 OHSS in Singleton and Twin Pregnancies 14.7 Spontaneous to Iatrogenic OHSS 14.8 Clinical Manifestation of Complications of OHSS 14.8.1 Ovarian Torsion 14.8.2 Ovarian Hemorrhage 14.8.3 Thromboembolism 15 Additional Risk Factors 15.1 Hepatic Complications 15.2 Renal Complications 15.3 Respiratory Complications 15.4 Cardiac Complications 15.5 Sepsis 16 Clinical Symptoms 16.1 Biological Findings 16.2 Laboratory Findings 17 Management 17.1 Outpatient Management 17.2 Inpatient Management 17.3 Medical Management 17.3.1 Fluid Administration 17.3.2 Plasma Expanders 17.3.3 Albumin Administration 17.3.4 Anticoagulants 17.4 Surgical Management 18 Prevention 18.1 Canceling the Cycle 18.2 Coasting 18.3 Early Unilateral Ovarian Follicular Aspiration 18.4 Modifying the Methods of Ovulation Triggering 18.5 Administration of Glucocorticoids 18.6 Cryopreservation of All Embryos 18.7 Electrocautery or Laser Vaporization of One or Both Ovaries 18.8 Reduction in the Number of Transferred Embryos 19 Conclusion References COVID-19 Infection in Obstetrical Patients Requiring Intensive Care: An Update 1 Introduction 2 Recognizing the High-Risk Patient 3 Oxygenation and Ventilatory Support 4 Pharmacological Agents in COVID-19 4.1 Corticosteroids 4.2 Immune-Modulating Agents 4.3 Remdesivir 4.4 Prevention of Venous Thromboembolism 5 Delivery of Fetus 6 Conclusion References ECMO in Peripartum Period: Lifesaving Therapeutic Intervention 1 Introduction 2 Types of ECMO 2.1 Functional Mechanics 3 ECMO in Peripartum 3.1 Indications of ECMO (Table 1) 3.2 ECMO Applications in Respiratory Failure 3.3 ECMO Application in Cardiogenic Shock 4 Contraindications to ECMO in Peripartum 5 Complications of ECMO in Pregnant Women 6 Special Consideration in Pregnant Women 7 Evidence and Outcome of V-V ECMO AND V-A ECMO Use in Peripartum 8 Conclusion References Infections in Obstetrics and Gynecology: An Intensive Care Perspective 1 Surgical Site Infection (SSI) 1.1 Risk Factors for SSI 1.2 Microbiology of SSI 1.3 Signs and Symptoms for SSI 1.4 Laboratory Test and Imaging Studies 1.5 Prevention of SSI 1.6 Preoperative Measures 1.7 Intraoperative Factors 1.8 Postoperative Factors 1.9 Management of Surgical Site Infection 2 Pelvic Inflammatory Diseases 2.1 Signs and Symptoms of PID 2.2 Diagnosis 2.3 Treatment 2.4 Mild to Moderate PID 2.5 Severe PID 2.6 Antibiotic Coverage for Anaerobic Bacteria Associated with PID 3 Urinary Tract Infections During Pregnancy 3.1 Pathogenesis 3.2 Microbiology 3.3 Diagnosis of UTIs 4 Acute Cystitis 4.1 Duration of Treatment 5 Pyelonephritis 5.1 Diagnostic Tests 5.2 Imaging Studies 5.3 Microbiology 5.4 Treatment 5.5 Antimicrobial Prophylaxis 6 Sexual Transmitted Disease (STDs) 6.1 Addressing the Global Challenge of Sexually Transmitted Infections (STIs) 6.2 Understanding Sexually Transmitted Infections (STIs) 6.3 Neisseria gonorrhoeae 6.4 Cervicitis 6.5 Urethritis 6.6 Pelvic Inflammatory Disease (PID) 6.7 Bartholinitis 6.8 Complications of Pregnancy 6.9 Other Infections Caused by N. Gonorrhoeae in Female Patients 6.9.1 Pharyngitis 6.9.2 Disseminated Gonococcal Infection 6.9.3 Conjunctivitis 6.10 Diagnostic Testing 6.10.1 Nucleic Acid Amplification (NAAT) 6.10.2 Testing for Extra Genital Specimens 6.10.3 Gram Stain (Microscopy) 6.10.4 Culture 6.10.5 Antigen Detection 6.10.6 Evaluation of Co-infection 6.10.7 Treatment of Neisseria Gonorrhoeae Infections 7 Pregnant Women 8 Prevention [45] 8.1 Behavioral Counseling 8.2 Maternal Immunization 8.3 Background 9 Conclusion References Radiological Imaging in the Intensive Care Management of Obstetric Emergencies: Safety Considerations, Best Practices, and Common Pathologies 1 Introduction 1.1 Why a Pregnant Woman Is in the ICU? 2 Principles of Imaging in Pregnancy and Obstetrics 3 Maternal Risk 4 Fetal Risk 4.1 Ultrasound Imaging 4.2 Magnetic Resonance Imaging 4.3 X- Ray Imaging 4.4 Commutated Tomography 4.5 Fluoroscopy/Interventional 4.6 Nuclear Medicine/Imaging 5 Imaging Contrast Usage in Pregnancy 6 Gastrointestinal and Genitourinary Pathology 6.1 Gastrointestinal Pathologies 6.1.1 Appendicitis 6.1.2 Bowel Obstruction 6.1.3 Inflammatory Bowel Disease 6.2 Genitourinary Pathologies 6.2.1 Obstructive Hydronephrosis 6.2.2 Ovarian Torsion 7 Neuro Imaging in Pregnancy 7.1 Preeclampsia-Eclampsia 7.2 Posterior Reversible Encephalopathy Syndrome (PRES) 7.3 Cerebral Venous Thrombosis 7.4 Embolism 7.5 Ischemic Stroke 7.6 Cerebral Hemorrhage 7.7 Pulmonary Thromboembolism (PTE) 8 Trauma in Pregnancy 9 Gynecological Conditions Leading to Intensive Care in a Pregnant Woman 9.1 Hemorrhagic Shock 10 Conclusion References