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There is an overall increase in plasma, red blood cells (RBCs) and total blood volume. Plasma volume increases by 15% during the first trimester; accelerates in the second trimester; peaks at around 32 weeks, reaching up to 50% above non-pregnant levels; and stays elevated until term. It returns to non-pregnant levels by 6 days post-delivery. There is often a sharp rise of up to 1 litre in plasma volume within the maternal circulation at 24 hours after delivery.
This chapter discusses the maternal and fetal implications, diagnostic signs, and management strategies for amniotic fluid embolus (AFE). Pulmonary oedema, acute respiratory distress syndrome, disseminated intravascular coagulopathy (DIC), pulmonary embolus, haemorrhage, right then let cardiac failure, cerebrovascular events, cardiorespiratory arrest, death are maternal implications of AFE. The first-line management involves resuscitation strategies. The main aim of early delivery is to facilitate and improve outcome of maternal resuscitation. The second-line management includes diagnosis and supportive care. The purpose of ICU is to monitor observations, maintain haemodynamic instability and reduce iatrogenic and disease complications. Options of treatment include diuretics, inotropes and steroids. Plasma exchange, haemofiltration and extracorporeal membrane oxygenation have been used in treatment. Regular fire drills involving maternal collapse on the labour ward can ensure that a robust system is in place for the acute management of AFE.
Pregnancy is associated with profound anatomical, physiological, biochemical and endocrine changes that affect multiple organs and systems. Red blood cell (RBC) volume falls during the first 8 weeks of pregnancy, increasing back to non-pregnant levels by 16 weeks and then rising to 30 percentage above non-pregnant levels by term. Marked physiological changes of cardiovascular system, respiratory system, renal system, and gastrointestinal system are significantly observed. During pregnancy the skin undergoes a number of changes, mainly thought to be due to hormonal changes. The additional demand for folate during pregnancy leads to a rapid fall in red cell folate and to a high incidence of megaloblastic anaemia in those women taking anticonvulsant drugs for control of epilepsy. For appendicectomy the type of incision depends on the gestation and the location of the appendix. The routine use of urinalysis for monitoring of glycaemic control during pregnancy is unreliable.
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