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Critical Care Obstetrics part 56

Critical Care Obstetrics part 56 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 | Overdose Poisoning and Envenomation During Pregnancy Teratogenic potential Majority of the evidence does not support it. The teratogenic potential of these agents generally falls in category C D Xm 39 . In one study chlordiazepoxide category D was associated with a fourfold increase in congenital anomalies 103 . However others have not found such associations 104 105 . Diazepam category D has been reported to be associated with oral clefts 106 107 . More recently retrospective and prospective studies have been unable to find an association between diazepam use during pregnancy and facial clefts or other defects in the offspring even among those patients exposed to high doses 108 109 110 . Fetal distress potential Only in the presence of severe maternal toxicity and secondary to maternal hypovolemia or hypoxemia. Indications for delivery Obstetric indications. Caution is suggested when interpreting fetal assessment techniques electronic fetal monitoring and biophysical profile . Postnatal Potential for neonatal hypotonia impaired temperature regulation lethargy and apnea needing resuscitation measures 111 . Risk of neonatal withdrawal may produce seizures 2-6 days after delivery. High-dose or recent use prior to delivery has been associated with birth depression and withdrawal stigmata in neonates the latter occurring up to 6 days after delivery 110 112 . Management considerations Wide therapeutic index low lethal potential if isolated poison. Investigate the possibility of coingestion particularly alcohol and tricyclics . The therapeutic goal with benzodiazepine overdose is supportive care and gradual withdrawal of the benzodiazepines in long-term abusers. Supportive Respiratory assistance may be required crystalloid infusion to maintain adequate volume dopamine and norepinephrine infusions may be required in refractory hypotension. If severe toxicity is present respiratory and cardiovascular support may be needed. Specific measures antidotes The first step is .