Critical Care and Obstetric Emergencies
Core concepts
Know the physiologic changes that alter critical care management in pregnancy: increased oxygen consumption, decreased functional residual capacity, compensated respiratory alkalosis, and increased cardiac output. Understand airway management challenges (edema, aspiration risk, difficult intubation) and the importance of left uterine displacement. Know the management of cardiac arrest in pregnancy, including perimortem cesarean delivery timing. Understand amniotic fluid embolism, eclampsia, septic shock, and massive transfusion principles.
Know the obstetric early warning systems and the importance of recognizing deterioration. Understand acute respiratory distress syndrome in pregnancy and the use of venovenous ECMO in selected cases. Be familiar with trauma in pregnancy and the importance of maternal stabilization first.
Traps
- Forgetting that normal blood pressure in pregnancy is lower; a "normal" pressure may be hypertensive for the patient.
- Delaying perimortem cesarean delivery beyond 4–5 minutes of arrest.
- Misinterpreting physiologic dyspnea and compensated respiratory alkalosis as pathology.
- Overlooking that amniotic fluid embolism is a clinical diagnosis.
- Assuming all vasopressors are contraindicated; some are appropriate in shock.
Rule of thumb
In any obstetric emergency, stabilize the mother first; fetal status follows maternal status. For cardiac arrest, start CPR, displace the uterus, and prepare for perimortem cesarean delivery if no return of circulation.
Worked example: A patient at 34 weeks has a witnessed cardiac arrest. Begin high-quality CPR with left uterine displacement, secure the airway, and if there is no return of spontaneous circulation within 4 minutes, proceed with perimortem cesarean delivery to improve maternal hemodynamics.