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Critical Care Obstetrics part 60

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Although the increased susceptibility to endotoxin - mediated injury in pregnant animals is a consistent observation in the lit- erature [104 – 106. As expected in an uncommon condition, the available human data regarding septic shock in human pregnancy are limited. Similar to the non - pregnant patient, septic shock in pregnant women was accompanied by an overall decrease in...

Critical Care Obstetrics part 61

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28 Daryani R , Lalonde C , Zhu D , et al. 29 Moore FA , Haenel JB , Moore EE , et al. 30 Poggetti RS , Moore FA , Moore EE , et al. 32 Fearon DT , Ruddy S , Schur PH , et al. 35 Hesse DG , Tracey KJ , Fong Y , et al....

Critical Care Obstetrics part 62

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a very low risk of inducing anaphylactoid reactions as compared to the high osmolality agents used in the past.. Volume overload from administration of RCM can lead to cardiogenic pulmonary edema that is not a hypersensitivity response and is part of the differential diagnosis of respiratory failure in this setting [52. Latex allergies remain one of the leading causes of...

Critical Care Obstetrics part 63

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a persistent sinusoidal FHR pattern in the absence of accelerations is a sign of potential fetal compromise.. This is true, regardless of whether otherwise “ worrisome ” features of the FHR tracing are present [5,6,37. Regardless of the approach used, the more simplifi ed approach of the CIPF or the more complicated one of the NICHD, a uniform approach for...

Critical Care Obstetrics part 64

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As a rule, the amount of hyperalimentation should be in keeping with the caloric requirements for that gestational age of the pregnancy and be suffi cient to avoid maternal hyperglycemia.. Because of the hypercoagulable state of pregnancy and the immobility of the brain - dead gravida, these patients also are at fl ow. With maternal brain death, the thermoregulatory center...

Critical Care Obstetrics part 65

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Given this short elimi- nation half - life, there are no studies examining placental transfer.. There are varied reports of the effect of adenosine on fetal heart tracings from no change to short episodes of fetal bradycardia [52,53. To date, there are no reports of human teratogenesis secondary to adenosine use.. There are no data specifi cally evaluating adenosine and...

Critical Care Obstetrics part 66

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The incidence of congenital heart disease in pregnant women is increasing in developed countries because of advances in the diagnosis and treatment of congenital heart defects in childhood.. Because of the physiologic changes in pregnancy, further deterioration in functional status in the range of 15 – 55% of symptomatic patients can be expected during pregnancy [2. In the United Kingdom...

Critical Care Obstetrics part 67

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atheromatous changes, narrowing of the arterial bed, and in situ thrombosis.. Diagnosis of pulmonary hypertension is confi rmed by various diagnostic modalities (Table 45.17. A recent study has revealed that echocardiography signifi cantly overestimates pulmonary artery pressures compared with cathe- terization in pregnant patients with suspected pulmonary hyper- tension. Thirty - two per cent of pregnant patients with normal pulmonary...

Critical Care Obstetrics part 68

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Proteinuria also occurs in 40% of renal transplant patients in the third trimester, but this characteristically resolves postpartum. Rejection of the renal graft with irreversible impairment of renal function during pregnancy or postpartum occurs in 10 – 20% of women, a risk similar to non - pregnant patients [36. The clinical hallmarks of rejection include fever, oliguria, deteriorating renal fuction,...

Critical Care Obstetrics part 69

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However, if a question persists and non - emergent treatment is indicated, then evaluation of the patient for competency is called for. Mahowald bases her arguments on four issues: the right to informed consent, the right of bodily integrity, the questionable personhood of the fetus, and the maternal risks in undergoing forced treatments such as cesarean section. Mahowald agrees with...

Critical Care Obstetrics part 70

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This may be due to pretrial settlements or to feelings on the part of the Witness that the injuries infl icted cannot be compensated by monetary awards [74]. Guidelines for a pproaching Jehovah ’ s Witness p atients One of the more important aspects in dealing with adult or eman- cipated Witness patients is for the physician to be honest...

Critical Care Obstetrics part 71

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A recent study of a United States population sample reported that fetal demise and infant death in the fi rst year after delivery increased the risk of a suicide attempt threefold (mostly poisonings) and increased inpatient psychiatric admis- sions [100. NMS is a rare complication of typical antipsychotic inadequate formal training in the management of hostile and. It is imperative...

Critical Care Obstetrics part 72

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A discussion of the potential maternal complications of fetal surgery is pertinent given the fact that such complications are in theory absolutely avoidable. As the term suggests, fetal surgery is performed for the sole physical benefi t of the fetus, and any risk to which the mother is exposed is for a purely altruistic purpose.. Many of the fi rst...

Critical Care Obstetrics part 73

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The management of ovarian cancer in pregnancy does not greatly differ from that of the non - pregnant patient. Alpha fetoprotein levels do change in pregnancy;. The epidemiology of cancer in pregnancy . 4 Smith LH , Danielsen B , Allen ME , et al. 6 Stepp KJ , Sauchak KA , O ’ Malley DM , et al. Obstet...

Critical Care Obstetrics part 74

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It has been suggested that using these com- pounds in the preconception period, until the pregnancy is diag- nosed, might decrease complications during pregnancy [26,27. It should be emphasized that excellent glycemic control before pregnancy may not only prevent or minimize the risk of congenital anomalies but also result in more stable renal function and lower complication rates later in...

Critical Care Obstetrics part 75

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It is an unfortunate reality that in many parts of the world there is an ongoing threat of terrorism against target groups that fre- quently include pregnant women. Pregnant women represent a unique population that differs from the populace at large both in terms of susceptibility to certain agents and in the management of any exposures. Transport and triage of...