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This chapter presents an overview on the current recommendations and guidelines that may be implemented to improve the management of planned and unplanned urgent high-risk obstetric patients and prevent fatal outcomes for both mothers and their babies. Reviewing morbidity and mortality data over the 10 years from 2000 reveals an increase in the proportion of indirect causes of maternal deaths and demonstrates that many of the case-fatalities were women who did not receive pre-pregnancy counseling or any specific medical management. The chapter discusses two examples of multidisciplinary care planning: for women who have placenta previa with acreta and have had a previous cesarean section and for women with a serious comorbidity. The goal of rapid response teams (RRTs) is to bring critical expertise and equipment to the patient without delay, in a timely manner, and to provide a solution to the problem in a standardized manner.
This chapter discusses the twin-to-twin transfusion syndrome (TTTS) treatment options focusing on fetoscopic laser ablation of anastomoses. It also explains the benefits and risks associated with this treatment. Fetoscopic laser coagulation of placental vessels (FLCPV) is the only treatment addressing the pathophysiology of the syndrome as proven through a randomized controlled study against amnioreduction. Septostomy is based on a deliberate opening of the intertwin membrane with the needle in order to let the amniotic fluid flow freely between the two amniotic sacs. Even though two randomized trials have yielded similar survival rates between amnioreduction and septostomy, it has been abandoned by most teams. The superiority of laser treatment over amnioreduction was established through a randomized controlled study. The type of anesthesia has also evolved with time since the first interventions. Some teams still operate under general anesthesia although it is significantly associated with significant maternal morbidity.
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