TAILIEUCHUNG - Critical Care Obstetrics part 66

Critical Care Obstetrics part 66 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 | 45 Anesthesia Considerations for the Critically Ill Parturient with Cardiac Disease Shobana Chandrasekhar Maya S. Suresh Department of Anesthesiology Baylor College of Medicine Houston TX USA Introduction and epidemiology Cardiac disease a leading cause of non- obstetric mortality in pregnancy occurs in 1-3 of pregnancies and accounts for 1015 of maternal mortality 1 2 . Even though the incidence of rheumatic heart disease is declining in developing countries it still accounts for a majority of mortality in obstetric cases. The incidence of congenital heart disease in pregnant women is increasing in developed countries because of advances in the diagnosis and treatment of congenital heart defects in childhood. Cardiovascular maternal morbidity and mortality during pregnancy correlate strongly with maternal functional status 1-3 . Women with NYHA class I and II no or minor symptoms tolerate pregnancy without major deterioration whereas those with NYHA class III and IV during pregnancy are at risk for major morbidity resulting in mortality upwards of 50 4 . Because of the physiologic changes in pregnancy further deterioration in functional status in the range of 15-55 of symptomatic patients can be expected during pregnancy 2 . When a pregnant woman presents with onset of cardiorespiratory deterioration the main differential diagnoses include thromboembolism cardiomyopathy dysrhythmia pre-eclampsia hemorrhage and sepsis. A less commonly considered differential is underlying heart disease and this is something that should be excluded in all of these cases. Therefore the diagnosis of cardiac disease by history physical exam ECG CXR and echocardiogram is essential to obstetric and anesthetic management. In the United Kingdom Report of the Confidential Enquiries into Maternal and Child Health CEMACH formerly Confidential Enquiries into Maternal Deaths CEMD cardiac disease was the second commonest cause of maternal mortality. Significant and increasing numbers of deaths .

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