Women with a broad spectrum of pathophysiological conditions—some of which in the past precluded pregnancy—benefit from the technology and expertise of critical care obstetrics. Common medical and surgical problems such as serious heart disease, acute or chronic pulmonary disorders, and trauma complicating pregnancy are just a few examples. Included also are severe obstetrical complications such as preeclampsia, hemorrhage, and sepsis syndrome. It is imperative that obstetricians and other members of the healthcare team have a working knowledge of the unique considerations for pregnant women. Because these women are usually young and in good health, their prognosis should be better than that of many other patients admitted to an intensive care unit.
Depending on methods and protocols at various institutions, approximately 1 percent of obstetrical patients need some type of intensive observation and management. Women with complications specific to pregnancy have the greatest need for obstetrical intensive care (Kuklina and associates, 2009; Madan and co-workers, 2008). As shown in Table 42-1, nearly half of these women need critical care for hypertensive disorders, hemorrhage, sepsis, or cardiopulmonary complications. With life-threatening hemorrhage, surgical procedures may be necessary, and close proximity to a delivery-operating room is advantageous. When admitted, a fourth of these women with serious medical or surgical disorders are still pregnant, and concerns for fetal well-being are usually better served by this close proximity. In our experiences from Parkland Hospital, Zeeman and colleagues (2003) reported that the most common nonobstetrical reasons for intensive care were usually encountered antepartum and included patients with diabetes, pneumonia or asthma, heart disease, chronic hypertension, pyelonephritis, or thyrotoxicosis.
Table 42-1. Indications for Admission to Intensive Care Units for Obstetrical Patients |Favorite Table|Download (.pdf)
Table 42-1. Indications for Admission to Intensive Care Units for Obstetrical Patients
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Organization of Critical Care
The concept and development of critical care began in the 1960s. In 1983, the National Institutes of Health had its first Consensus Conference on this subject, and in 1988, the Society for Critical Care Medicine promulgated definitions and established guidelines for intensive care units (ICUs). These continue to be refined by certifying organizations (Manthous, 2004).
Because of high costs incurred by medical and surgical ICUs, a step-down intermediate care unit evolved. These ...