TAILIEUCHUNG - Critical Care Obstetrics part 4

Critical Care Obstetrics part 4 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 | Critical Care Obstetric Nursing complicated by a postoperative myocardial infarction MI . Subsequent care included cardiac rehabilitation with exercise and medications to optimize cardiac function. Echocardiograms performed during the period of cardiac rehabilitation revealed the presence of persistent decreased left ventricular dysfunction and mild pulmonary hypertension. Her obstetric history was significant for an unplanned pregnancy which occurred approximately 1 year following her CABG and MI. She decided to undergo termination of the pregnancy after consultation with a cardiologist and perinatologist. Less than a year later she presented at 9 weeks estimated fetal gestational age EGA for consultation with a perinatologist. She was subsequently referred to a perinatologist at a local tertiary care center. Initial evaluation included an echocardiogram which indicated persistent moderate to severe left ventricular dysfunction an ejection fraction between 25 and 30 and elevated pulmonary artery pressures. The consultation included a thorough discussion with the patient and her husband of the potential risk of morbidity and mortality associated with continuation of the pregnancy as well as components of a multidisciplinary plan of care should continuation of the pregnancy be desired. Both the patient and her husband verbalized a strong desire to continue the pregnancy. Thus prenatal care continued without development of additional maternal or fetal complications. She was admitted to the CCOB service at 39 weeks gestation for planned induction of labor and vaginal delivery. Any decision to perform a cesarean section would be based on development of obstetric indications. Maternal and fetal assessment findings at the time of admission were all reassuring. Occasional uterine contractions were noted and her cervix was approximately 1 cm dilated and long. On the evening of admission the induction process was started with the insertion of a Foley catheter into the .

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337    146    2    27-12-2024
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