Critical Care Obstetrics Critical Care Obstetrics Sixth Edition Editor‐in‐Chief Jeffrey P Phelan President and Director of Clinical Research, Childbirth Injury Prevention Foundation, Glendora, CA; San Gabriel Valley Perinatal Medical Group, Inc., West Covina, CA; and Former Director of Quality Assurance, Department of Obstetrics and Gynecology, Citrus Valley Medical Center, West Covina, CA, USA Editors Luis D Pacheco Professor of Departments of Obstetrics, Gynecology, and Anesthesiology, Divisions of Maternal Fetal Medicine and Surgical Critical Care, The University of Texas Medical Branch, Galveston, TX, USA Michael R Foley Professor and Chair, Department of Obstetrics and Gynecology, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA George R Saade Professor of Obstetrics & Gynecology, and Cell Biology, Chief of Obstetrics and Maternal Fetal Medicine, University of Texas Medical Branch, Galveston, TX, USA Gary A Dildy Professor of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA Michael A Belfort Professor of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA This sixth edition first published 2019 © 2019 by John Wiley & Sons Ltd Edition History [John Wiley and Sons 5e, 2011] All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions The right of Jeffrey P Phelan, Luis D Pacheco, Michael R Foley, George R Saade, Gary A Dildy, and Michael A Belfort to be identified as the authors of editorial in this work has been asserted in accordance with law Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, 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the understanding that the publisher is not engaged in rendering professional services The advice and strategies contained herein may not be suitable for your situation You should consult with a specialist where appropriate Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages Library of Congress Cataloging‐in‐Publication Data Names: Phelan, Jeffrey P., editor Title: Critical care obstetrics / editor-in-chief, Jeffrey P Phelan ; editors, Luis D Pacheco, Michael R Foley, George R Saade, Gary A Dildy, Michael A Belfort Other titles: Critical care obstetrics (Clark) Description: 6th edition | Hoboken, NJ, USA : Wiley-Blackwell, [2019] | Includes bibliographical references and index | Identifiers: LCCN 2018016215 (print) | LCCN 2018017095 (ebook) | ISBN 9781119129394 (Adobe PDF) | ISBN 9781119129387 (ePub) | ISBN 9781119129370 (hardback) Subjects: | MESH: Pregnancy Complications | Critical Care–methods Classification: LCC RG571 (ebook) | LCC RG571 (print) | NLM WQ 240 | DDC 618.3/028–dc23 LC record available at https://lccn.loc.gov/2018016215 Cover design: Wiley Cover image: © Petri Oeschger/Getty Images; © Mikael Damkier/Shutterstock; © Dan Alto/Shutterstock Set in 10/12pt Warnock by SPi Global, Pondicherry, India 10 v Contents List of Contributors ix Foreword to the Sixth Edition xvii Part One Basic Critical Care Clinical and Surgical Principles 1 Epidemiology of Critical Illness in Pregnancy Cande V Ananth and John C Smulian Organizing an Obstetrical Critical Care Unit: Care without Walls 17 Julie Scott and Michael R Foley Critical Care Obstetric Nursing 27 Nan H Troiano and Suzanne McMurtry Baird Pregnancy‐Induced Physiologic Alterations 41 Errol R Norwitz and Julian N Robinson Maternal Blood Gas Physiology 69 Aaron B Caughey Fluid and Electrolyte Balance 87 William E Scorza, Sharon Maynard, and Anthony Scardella Interventional Radiology in Pregnancy 115 Sheena A Pimpalwar and Michael A Belfort Fetal Considerations in the Critically Ill Gravida 123 Jeffrey P Phelan Fetal Effects of Drugs Commonly Used in Critical Care 151 Sarah Gloria Običan and Jerome Yankowitz 10 Maternal‐Fetal Oxygenation 175 Alfred D Fleming and Marsha Henn 11 Cardiopulmonary Resuscitation (CPR) in Pregnancy 183 Terri‐Ann Bennett and Carolyn M Zelop 12 Neonatal Resuscitation 193 Jay P Goldsmith and Gilbert I Martin vi Contents 13 Ventilator Management in Critical Illness 215 Luis D Pacheco and Antonio Saad 14 Vascular Access 249 Gayle Olson and Aristides P Koutrouvelis 15 Nutritional Support 265 Bill Tang, Michael J Tang, and Jeffrey P Phelan 16 Dialysis in Pregnancy 273 Evan I Fisher, Shad H Deering, and James D Oliver III 17 Cardiopulmonary Bypass 285 Alexis L McQuitty 18 Noninvasive Monitoring in Critical Care 303 Amir Shamshirsaz and Michael A Belfort 19 Obstetric Analgesia and Anesthesia 315 M James Lozada, Rovnat Babazade, and Rakesh B Vadhera 20 Critical Care Drills in Obstetrics 331 Monica A Lutgendorf and Shad H Deering 21 Maternal‐Fetal Transport in the High‐Risk Pregnancy 347 Albert P Sarno, Joshua A Makhoul, and John C Smulian Part Two Acute Emergencies 359 361 22 Seizures and Status Epilepticus Michael W Varner 23 Acute Spinal Cord Injury 369 Lisa R Wenzel, Angela Vrooman, and Hunter A Hammill 24 Severe Acute Asthma 391 Dharani K Narendra and Nicola A Hanania 25 Acute Respiratory Distress Syndrome in Pregnancy 403 Dharani K Narendra, David Muigai, and Kalpalatha K Guntupalli 26 Cardiogenic Pulmonary Edema 419 Wayne J Franklin and William C Mabie 27 The Acute Abdomen during Pregnancy 429 Ibrahim A Hammad and Howard T Sharp 28 Acute Pancreatitis 441 Anna S Leung and Jeffrey P Phelan 29 Acute Renal Injury 457 Kristen L Elmezzi, Caroline C Marrs, C Luke Dixon, Shad H Deering, and Giuseppe Chiossi Contents 30 Acute Fatty Liver of Pregnancy 471 Ibrahim A Hammad and T Flint Porter 31 Disseminated Intravascular Coagulation 479 Nazli Hossain and Michael J Paidas 32 Endocrine Emergencies 487 Mary Catherine Tolcher, Heather S Hoff, and Kjersti Marie Aagaard 33 Acute Psychiatric Conditions in Pregnancy 501 Lucy J Puryear 34 Diabetic Ketoacidosis 519 Mark A Curran Part Three Shock in Pregnancy 533 35 Hypovolemic Shock 535 Jerasimos Ballas and Scott Roberts 36 Blood Component Therapy and Massive Transfusion 547 Shiu‐Ki Rocky Hui, Kjersti Marie Aagaard, and Jun Teruya 37 Etiology and Management of Hemorrhage 569 Irene A Stafford, Michael A Belfort, and Gary A Dildy 38 Septic Shock 599 Sonya S Abdel‐Razeq and Errol R Norwitz 39 Cardiogenic Shock 631 Scott Roberts and Martha W.F Rac 40 Anaphylactic Shock in Pregnancy 641 Raymond O Powrie 41 Amniotic Fluid Embolism 653 Gary A Dildy, Michael A Belfort, and Steven L Clark Part Four Medical and Surgical Management 671 42 Pregnancy‐Related Stroke 673 Jamil ElFarra and James N Martin, Jr 43 Cardiac Disease and Pregnancy 699 Wayne J Franklin, Roxann Rokey, Michael R Foley, and Michael A Belfort 44 Anesthetic Considerations in the Critically Ill Gravida with Cardiac Disease 731 Shobana Murugan, Lisa Mouzi Wofford, Sandeep Markan, and Yi Deng 45 Thromboembolic Disease 755 Martha Pritchett Mims vii viii Contents 46 Pulmonary Hypertension in Pregnancy 775 Mohammed F Zaidan and Alexander G Duarte 47 Sickle Cell Disease and Pregnancy 791 Iberia Romina Sosa and Mark M Udden 48 Thrombotic Thrombocytopenic Purpura, Hemolytic‐Uremic Syndrome, and HELLP 803 Kelty R Baker 49 The Placenta as a Critical Care Issue 821 Karin A Fox, Martha W.F Rac, Alireza A Shamshirsaz, and Michael A Belfort 50 Complications of Preeclampsia 837 Mary Catherine Tolcher, Hector Mendez‐Figueroa, and Kjersti Marie Aagaard 51 Systemic Lupus Erythematosus and Antiphospholipid Syndrome 873 Fawzi Saoud and Maged M Costantine 52 Trauma in Pregnancy 891 Robert Rossi, Alfredo F Gei, and James W Van Hook 53 Thermal and Electrical Injury 919 Cornelia R Graves 54 Overdose, Poisoning, and Envenomation during Pregnancy 927 Alfredo F Gei, Victor R Suarez, and James W Van Hook 55 The Organ Transplant Patient in the Obstetric Critical Care Setting 985 Calla Holmgren and James R Scott 56 Fetal Surgery Procedures and Associated Maternal Complications 997 Alireza A Shamshirsaz, Venkata Bandi, David Muigai, R H Ball, and Michael A Belfort 57 Cancer in the Pregnant Patient 1005 Kristin Bixel, Kenneth H Kim, and David M O’Malley 58 Mass Casualties and the Obstetrical Patient 1023 Lisa M Foglia and Peter E Nielsen 59 Biological, Chemical, and Radiological Exposures in Pregnancy 1027 Lisa M Foglia and Peter E Nielsen Part Five Ethical and Legal Considerations 1037 60 Ethics in the Obstetric Critical Care Setting 1039 Fidelma B Rigby 61 Medical‐Legal Considerations in Critical Care Obstetrics 1063 Jeffrey P Phelan Index 1085 ix List of Contributors Kjersti Marie Aagaard, MD, PhD, FACOG Henry and Emma Meyer Chair in Obstetrics & Gynecology Professor & Vice Chair of Research Department of Obstetrics and Gynecology Division of Maternal‐Fetal Medicine Baylor College of Medicine and Texas Children’s Hospital Houston, TX, USA Sonya S Abdel‐Razeq, MD Assistant Professor Obstetrics, Gynecology, and Reproductive Sciences Yale University New Haven, CT, USA Cande V Ananth, PhD, MPH Department of Obstetrics and Gynecology College of Physicians and Surgeons Department of Epidemiology Joseph L Mailman School of Public Health Columbia University New York, NY, USA Rovnat Babazade, MD Department of Anesthesiology The University of Texas Medical Branch Galveston, TX, USA Suzanne McMurtry Baird, DNP, RN Owner and Nursing Director, Clinical Concepts in Obstetrics, Inc Brentwood, TN, USA; Labor and Delivery, Vanderbilt University Medical Center, Nashville, TN, USA Kelty R Baker, MD, PA Houston Methodist Hospital Houston, TX, USA R.H Ball, BM, BCh Baylor College of Medicine Houston, TX, USA Jerasimos Ballas, MD, MPH Assistant Professor, Department of Obstetrics and Gynecology Baylor College of Medicine Ben Taub Hospital Texas Children’s Pavilion for Women Houston, TX, USA Venkata Bandi, MD Baylor College of Medicine Houston, TX, USA Michael A Belfort, MBBCH, MD, PhD Professor, Department of Obstetrics and Gynecology Division of Maternal Fetal-Medicine, Baylor College of Medicine Houston, TX, USA Terri‐Ann Bennett, MD Division of Maternal‐Fetal Medicine Department of Obstetrics and Gynecology New York University Langone Medical Center New York, NY, USA Kristin Bixel, MD Division of Gynecologic Oncology Department of Obstetrics and Gynecology James Cancer Hospital and Solove Research Institute The Ohio State University Columbus, OH, USA Aaron B Caughey, MD, PhD Professor and Chair, Department of Obstetrics & Gynecology; Women’s Health Research & Policy Oregon Health & Science University Portland, OR, USA Giuseppe Chiossi, MD Department of Obstetrics & Gynaecology Division of Maternal and fetal Medicine The University of Texas Medical Branch Galveston, TX, USA x List of Contributors Steven L Clark, MD Evan I Fisher, MD, Major, USAF MC, Nephrologist wPAFB Department of Obstetrics and Gynecology Baylor College of Medicine Houston, TX, USA Nephrology Service Department of Medicine Walter Reed National Military Medical Center Uniformed Services University of the Health Sciences Bethesda, MD, USA Maged M Costantine, MD Associate Professor, Division of Maternal Fetal Medicine The University of Texas Medical Branch Galveston, TX, USA Mark A Curran, MD San Gabriel Valley Perinatal Medical Group, Inc West Covina, CA, USA Shad H Deering, MD Professor and Chair, Department of Obstetrics and Gynecology Uniformed Services University of the Health Sciences Bethesda, MD, USA Yi Deng, MD Assistant Professor, Cardiac Anesthesia and Critical Care Ben Taub General Hospital Baylor College of Medicine Houston, TX, USA Gary A Dildy, MD Professor Department of Obstetrics and Gynecology Baylor College of Medicine Houston, TX, USA C Luke Dixon, MD Department of Obstetrics and Gynecology Division of Maternal and Fetal Medicine The University of Texas Medical Branch Galveston, TX, USA Alexander G Duarte, MD Professor, Division of Pulmonary, Critical Care and Sleep Medicine The University of Texas Medical Branch Galveston, TX, USA Jamil ElFarra, MD, FACOG Attending Physician, Maternal Fetal Medicine Norton Healthcare Louisville, KY, USA Kristen L Elmezzi, DO Department of Obstetrics and Gynecology Uniformed Services University of the Health Sciences Bethesda, MD, USA Alfred D Fleming, MD Chairman, Department of Obstetrics and Gynecology Director, Maternal‐Fetal Medicine Saint Luke’s Regional Medical Center Sioux City, IA, USA Lisa M Foglia, MD, FACOG, Col USARMY Associate Professor, Uniformed Services University of the Health Sciences, Medical Education and Research DIO; Director Womack Army Medical Center, Fayetteville, NC, USA Michael R Foley, MD Professor and Chair, Department of Obstetrics and Gynecology University of Arizona College of Medicine Phoenix Phoenix, AZ, USA Karin A Fox, MD, MEd, FACOG Assistant Professor, Associate Fellowship Director, and Co‐Chief Maternal‐Fetal Surgery Section Division of Maternal‐Fetal Medicine Department of Obstetrics and Gynecology Baylor College of Medicine; The Pavilion for Women Texas Children’s Hospital Houston, TX, USA Wayne J Franklin, MD Head, Department of Adult Medicine Director, Adult Congenital Heart Disease Program Texas Children’s Hospital Associate Professor of Medicine and Pediatrics Associate Professor of Obstetrics and Gynecology Baylor College of Medicine Houston, TX, USA Alfredo F Gei, MD, PA Department of Obstetrics and Gynecology Division of Maternal‐Fetal Medicine The Methodist Hospital Houston, TX, USA .. .Critical Care Obstetrics Critical Care Obstetrics Sixth Edition Editor‐in‐Chief Jeffrey P Phelan President and Director... Title: Critical care obstetrics / editor-in-chief, Jeffrey P Phelan ; editors, Luis D Pacheco, Michael R Foley, George R Saade, Gary A Dildy, Michael A Belfort Other titles: Critical care obstetrics. .. One Basic Critical Care Clinical and Surgical Principles 1 Epidemiology of Critical Illness in Pregnancy Cande V Ananth and John C Smulian Organizing an Obstetrical Critical Care Unit: Care without