Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic science
- Part II Clinical Practice
- 17 Classification and diagnosis of pre-eclampsia
- 18 Measuring blood pressure in pregnancy and pre-eclampsia
- 19 Immune maladaptation in the etiology of pre-eclampsia; an updated epidemiological perspective
- 20 Genetics of pre-eclampsia and counseling the patient who developed pre-eclampsia
- 21 Thrombophilias and pre-eclampsia
- 22 Medical illness and the risk of pre-eclampsia
- 23 The kidney and pre-eclampsia
- 24 Management of mild pre-eclampsia
- 25 Management of severe pre-eclampsia
- 26 The differential diagnosis of pre-eclampsia and eclampsia
- 27 Complications of pre-eclampsia
- 28 Central nervous system findings in pre-eclampsia and eclampsia
- 29 Pathogenesis and treatment of eclampsia
- 30 Anesthesia for the pre-eclamptic patient
- 31 Critical care management of severe pre-eclampsia
- 32 The role of maternal and fetal Doppler in pre-eclampsia
- 33 Pregnancy-induced hypertension – the effects on the newborn
- 34 Medico-legal implications of the diagnosis of pre-eclampsia
- Subject index
- References
31 - Critical care management of severe pre-eclampsia
from Part II - Clinical Practice
Published online by Cambridge University Press: 03 September 2009
By
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic science
- Part II Clinical Practice
- 17 Classification and diagnosis of pre-eclampsia
- 18 Measuring blood pressure in pregnancy and pre-eclampsia
- 19 Immune maladaptation in the etiology of pre-eclampsia; an updated epidemiological perspective
- 20 Genetics of pre-eclampsia and counseling the patient who developed pre-eclampsia
- 21 Thrombophilias and pre-eclampsia
- 22 Medical illness and the risk of pre-eclampsia
- 23 The kidney and pre-eclampsia
- 24 Management of mild pre-eclampsia
- 25 Management of severe pre-eclampsia
- 26 The differential diagnosis of pre-eclampsia and eclampsia
- 27 Complications of pre-eclampsia
- 28 Central nervous system findings in pre-eclampsia and eclampsia
- 29 Pathogenesis and treatment of eclampsia
- 30 Anesthesia for the pre-eclamptic patient
- 31 Critical care management of severe pre-eclampsia
- 32 The role of maternal and fetal Doppler in pre-eclampsia
- 33 Pregnancy-induced hypertension – the effects on the newborn
- 34 Medico-legal implications of the diagnosis of pre-eclampsia
- Subject index
- References
Summary
Pre-eclampsia remains one of the leading causes of maternal mortality in developing and industrialized societies and affects 2–6% of pregnant women (Duley, 1992; Hogberg et al., 1994; WHO, 1988). Eclampsia with or without evidence of intracranial hemorrhage is the single most lethal complication of pre-eclampsia/eclampsia. Deaths have also been associated with pulmonary edema, HELLP syndrome, renal failure and the development of hypovolemia (commonly due to concurrent abruptio placentae). Some of the factors that predispose to a poor outcome include inadequate access to medical care resulting in delayed hospitalization and substandard care arising from inappropriate management. The provision of medical facilities is a socioeconomic priority that may not be easy to implement. The development of skills and knowledge necessary to care for critically ill pre-eclamptic women is a far more attainable goal and should be widely taught to all categories of medical staff.
Obstetric critical care is largely dependent on information derived from small (usually observational) studies, although there are now some randomized studies that inform clinical practice. The absence of an overwhelming burden of epidemiological evidence does not preclude the need for intervention and some of the principles of management, especially those based upon expert opinion alone, may change in time as further epidemiological data become available.
This chapter will briefly outline pathologic changes in the major organ systems affected in pre-eclampsia, discuss the role of monitoring in the intensive care unit, and will address the specific complications of severe pre-eclampsia that necessitate intensive care.
- Type
- Chapter
- Information
- Pre-eclampsiaEtiology and Clinical Practice, pp. 476 - 488Publisher: Cambridge University PressPrint publication year: 2007
References
and (1984). Interactions of Mg and K on cerebral vessels – aspects in view of stroke. Review of present status and new findings. Magnesium, 3(4–6), 195–211.Google Scholar
(1993). Magnesium and cardiovascular disease. Prog. Cardiovasc. Dis., 35(4), 271–310.CrossRefGoogle ScholarPubMed
, , , and (1982). Thrombotic thrombocytopenic purpura in pregnancy. Br. J. Obstet. Gynaecol., 89(6), 476–9.CrossRefGoogle ScholarPubMed
and (1990). Myasthenia gravis presenting as weakness after magnesium administration. Muscle Nerve, 13(8), 708–12.CrossRefGoogle ScholarPubMed
(1992). The effect of magnesium sulphate on blood flow velocity in the maternal retina in mild pre-eclampsia, a preliminary colour flow, Doppler study. Br. J. Obstet. Gynaecol., 99(8), 641–5.CrossRefGoogle ScholarPubMed
and (1992). Effect of magnesium sulfate on maternal brain blood flow in preeclampsia: a randomized, placebo-controlled study. Am. J. Obstet. Gynecol., 167(3), 661–6.CrossRefGoogle ScholarPubMed
and (1993). Retinal vasospasm associated with visual disturbance in preeclampsia: color flow Doppler findings. Am. J. Obstet. Gynecol., 169(3), 523–5.CrossRefGoogle ScholarPubMed
, and (1991). Respiratory function in severe gestational proteinuric hypertension: the effects of rapid volume expansion and subsequent vasodilatation with verapamil. Br. J. Obstet. Gynaecol., 98(10), 964–72.CrossRefGoogle ScholarPubMed
, and (1992). The effect of magnesium sulfate on maternal retinal blood flow in preeclampsia: a randomized placebo-controlled study. Am. J. Obstet. Gynecol., 167(6), 1548–53.CrossRefGoogle ScholarPubMed
, , and (1994). Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients. Am. J. Obstet. Gynecol., 171(4), 884–92.CrossRefGoogle ScholarPubMed
, , , and (1997). Two-dimensional echocardiography and Doppler ultrasound in managing obstetric patients. Obstet. Gynecol., 90(3), 326–30.CrossRefGoogle ScholarPubMed
, , and (1999a). Preeclampsia may cause both overperfusion and underperfusion of the brain: a cerebral perfusion pressure based model. Acta Obstet. Gynecol. Scand., 78(7), 586–91.CrossRefGoogle Scholar
, , , , and (1999b). Effect of blood pressure on orbital and middle cerebral artery resistance in healthy pregnant women and women with preeclampsia. Am. J. Obstet. Gynecol., 180, 601–7.CrossRefGoogle Scholar
, , , et al. (2000). Evaluation of a non-invasive transcranial Doppler and blood pressure bases method for the assessment of cerebral perfusion pressure in pregnant women. Hypertens. Pregn., 19(3), 331–40.CrossRefGoogle Scholar
, , , et al. (2001). Changes in flow velocity, resistance indices, and cerebral perfusion pressure in the maternal middle cerebral artery distribution during normal pregnancy. Acta Obstet. Gynecol. Scand., 80, 104–12.Google ScholarPubMed
, , , and (2002a). Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. Am. J. Obstet. Gynecol., 187, 626–34.CrossRefGoogle Scholar
, , , and (2002b). Labetalol decreases cerebral perfusion pressure without negatively affecting cerebral blood flow in hypertensive gravidas. Hypertens. Pregn., 21(3), 185–97.CrossRefGoogle Scholar
, , and (2003). Successful treatment of life–threatening postparturn hermorrhage with recombinant activated factor VII. Obstet. Gynecol., 101, 1174–6Google Scholar
, and (1992). Spontaneous resolution of pre-eclampsia-related thrombocytopenia. Br. J. Obstet. Gynaecol., 99(11), 887–90.CrossRefGoogle ScholarPubMed
and (2002). Various clinical manifestations in patients with thrombotic microangiopathy. J. Investig. Med., 50(3), 201–6.CrossRefGoogle ScholarPubMed
, , and (1986). Severe preeclampsia with persistent oliguria: management of hemodynamic subsets. Am. J. Obstet. Gynecol., 154(3), 490–4.CrossRefGoogle ScholarPubMed
, , , and (1995). Amniotic fluid embolism: analysis of the national registry. Am. J. Obstet. Gynecol., 172(4, Pt. 1), 1158–67.CrossRefGoogle ScholarPubMed
, and (1998). A randomised controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre-eclampsia. Br. J. Obstet. Gynaecol., 105(3), 300–3.CrossRefGoogle ScholarPubMed
Collaborative Eclampsia Trial. (1995). Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet, 345(8963), 1455–63.CrossRef
, and (1993). Alterations in vitamin D and calcium metabolism with magnesium sulfate treatment of preeclampsia. Am. J. Obstet. Gynecol., 168(4), 1170–6.CrossRefGoogle ScholarPubMed
, , , and (2003). Successful treatment with recombinant factor VIIa for intractable bleeding at pelvic surgery. Obstet. Gynecol., 101, 1172–3Google ScholarPubMed
and (1988). The classification and definition of the hypertensive disorders of pregnancy. Am. J. Obstet. Gynecol., 158(4), 892–8.CrossRefGoogle ScholarPubMed
and (1994). Eclampsia in the United Kingdom. Br. Med. J., 309(6966), 1395–400.CrossRefGoogle ScholarPubMed
(1992). Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br. J. Obstet. Gynaecol., 99(7), 547–53.CrossRefGoogle ScholarPubMed
, , , , and (1989). Blindness in eclampsia: CT and MR imaging. J. Neurol. Neurosurg. Psychiatry., 52(7), 899–902.CrossRefGoogle ScholarPubMed
and (1975). The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia., 16(1), 1–66.CrossRefGoogle ScholarPubMed
(1985). Acute fatty liver of pregnancy. N. Engl. J. Med., 313(6), 367–70.CrossRefGoogle ScholarPubMed
(1996). Pre-eclampsia–eclampsia 1996: preventable? Have disputes on its treatment been resolved?Curr. Opin. Nephrol. Hypertens., 5(5), 452–8.CrossRefGoogle ScholarPubMed
, , , , and (1994). Late postpartum eclampsia revisited. Obstet. Gynecol., 83(4), 502–5.CrossRefGoogle ScholarPubMed
, and (1992). Adult respiratory distress syndrome in pregnancy. Am. J. Obstet. Gynecol., 167(4, Pt. 1), 950–7.CrossRefGoogle ScholarPubMed
and (1997). Low dose dopamine in postpartum pre-eclamptic women with oliguria: a double-blind, placebo controlled, randomised trial. Br. J. Obstet. Gynaecol., 104(10), 1180–3.CrossRefGoogle ScholarPubMed
, and (1990). Computed tomography of the brain in eclampsia. Obstet. Gynecol., 75(6), 975–80.Google ScholarPubMed
, , , , and (1997). Cerebral blood flow and cranial magnetic resonance imaging in eclampsia and severe preeclampsia. Obstet. Gynecol., 89(4), 561–8.Google ScholarPubMed
, , , , and (1999). Comparison of auscultatory and oscillometric automated blood pressure monitors in the setting of preeclampsia. Am. J. Obstet. Gynecol., 181(5, Pt. 1), 1203–10.CrossRefGoogle ScholarPubMed
and (1975). A paradoxical cerebral hemodynamic effect of hydralazine. Stroke, 6(4), 402–10.CrossRefGoogle ScholarPubMed
, , , et al. (2002). Thrombotic thrombocytopenic purpura and pregnancy: a case report and a review of the literature. Ann. Hematol., 81(4), 210–11.Google Scholar
and (2002). Severe hepatic dysfunction in pregnancy. Q. J. Med., 95(6), 343–57.CrossRefGoogle ScholarPubMed
, , and (1988). Neuromuscular transmission studies in preeclamptic women receiving magnesium sulfate. Am. J. Obstet. Gynecol., 158(1), 40–6.CrossRefGoogle ScholarPubMed
, and (1985). Cardiopulmonary arrest after the administration of magnesium sulphate. A case report. S. Afr. Med. J., 67(4), 145.Google ScholarPubMed
, , and (1986). Active management of the unconscious eclamptic patient. Br. J. Obstet. Gynaecol., 93(6), 554–62.CrossRefGoogle ScholarPubMed
, , and (1997). Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke, 28(5), 1082–5.CrossRefGoogle Scholar
, , , et al. (1992). Hypertensive encephalopathy: findings on CT, MR imaging, and SPECT imaging in 14 cases. Am. J. Roentgenol., 159(2), 379–83.CrossRefGoogle ScholarPubMed
(1990). Eclampsia. VI. Maternal–perinatal outcome in 254 consecutive cases. Am. J. Obstet. Gynecol., 163(3), 1049–54.CrossRefGoogle ScholarPubMed
, , , et al. (1999). Inherited long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency and a fetal–maternal interaction cause maternal liver disease and other pregnancy complications. Semin. Perinatol., 23(2), 100–12.CrossRefGoogle Scholar
and (1994). Postpartum eclampsia. Impossible to eradicate?Clin. Exp. Obstet. Gynecol., 21(2), 74–6.Google Scholar
, , , and (1993). Cocaine intoxication presenting as preeclampsia and eclampsia. Obstet. Gynecol., 81(4), 545–7.Google ScholarPubMed
and (1991). Central hemodynamic observations in untreated preeclamptic patients. Hypertension., 17(6, Pt. 2), 1072–7.CrossRefGoogle ScholarPubMed
(1982). Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am. J. Obstet. Gynecol., 142(2), 159–67.CrossRefGoogle ScholarPubMed
and (1995). Maternal cerebral blood flow changes associated with eclampsia. Am. J. Perinatol., 12(3), 189–91.CrossRefGoogle ScholarPubMed
WHO. (1988). Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Am. J. Obstet. Gynecol., 158(1), 80–3.
, , , , and (1995). Cerebral hemodynamics in pre-eclampsia/eclampsia syndrome. Ultrasound Obstet. Gynecol., 6(6), 411–15.CrossRefGoogle ScholarPubMed