General Management Principles of the Pregnant Woman

2017 ◽  
Vol 38 (02) ◽  
pp. 123-134
Author(s):  
Margaret Miller ◽  
Amanpreet Kaur
Keyword(s):  
Cardiopulmonary Arrest ◽  
Patient Positioning ◽  
Signs And Symptoms ◽  
Diagnostic Procedures ◽  
Pregnant Patient ◽  
Physiological Changes ◽  
Limited Data ◽  
Chest Compressions ◽  
General Management ◽  
In Pregnancy

AbstractPregnancy is a dynamic process that consists of profound physiological changes mediated by hormonal, mechanical, and circulatory pathways. Understanding of changes in physiology is essential for distinguishing abnormal and normal signs and symptoms in a pregnant patient. These physiological changes also have important pharmacotherapeutic considerations for a pregnant patient. Although there are limited data to guide decisions regarding medications and diagnostic procedures in pregnancy, a careful review of risks should be balanced with review of risk of withholding a medication or procedure. Interventional pulmonary procedures can be safely performed in pregnant women while keeping in mind the maternal anatomic and physiologic changes. Furthermore, management of a maternal cardiopulmonary arrest requires important modifications in patient positioning and intravenous access to ensure adequate efficacy of chest compressions, circulation, and airway management. This review will provide an overview of maternal physiologic changes with a focus on cardiopulmonary physiology, pharmacotherapeutic considerations, diagnostic and interventional pulmonary procedures during pregnancy, and cardiopulmonary resuscitation in pregnancy.

scholarly journals Microcirculation in Pregnancy

2014 ◽  
pp. 395-408 ◽  
Author(s):  
I. ABDO ◽  
R. B. GEORGE ◽  
M. FARRAG ◽  
V. CERNY ◽  
C. LEHMANN
Keyword(s):  
Pregnant Woman ◽  
Oxygen Supply ◽  
Pregnant Patient ◽  
Physiological Changes ◽  
Patient Will ◽  
Measurement And Evaluation ◽  
Physiological Systems ◽  
In Pregnancy

The microcirculation, like all physiological systems undergoes modifications during the course of pregnancy. These changes aid the adaption to the new anatomical and physiological environment of pregnancy and ensure adequate oxygen supply to the fetus. Even though the microcirculation is believed to be involved in major pregnancy related pathologies, it remains poorly understood. The availability of safe and non-interventional technologies enabling scientists to study the intact microcirculation of the pregnant patient will hopefully expand our understanding. In this article we review the physiological changes occurring in the microcirculation during pregnancy and the role of the microcirculation in gestational related pathologies. We will also describe the available techniques for the measurement and evaluation of the microcirculation. Lastly we will highlight the possible fields in which these techniques could be utilized to help provide a clearer view of the microcirculation in the pregnant woman.

Sepsis in obstetrics

2016 ◽  
Author(s):  
Nuala Lucas ◽  
Colleen D. Acosta ◽  
Marian Knight
Keyword(s):  
Pregnant Patient ◽  
Physiological Changes ◽  
Risk Of Infection ◽  
Surviving Sepsis Campaign ◽  
Fetal Demise ◽  
Major Morbidity ◽  
Mortality And Morbidity ◽  
Management Of Complications ◽  
Maternal Mortality And Morbidity ◽  
In Pregnancy

Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion, and infertility. Sepsis may arise at any time during pregnancy and the puerperium. Prior to the advent of routine prophylactic antibiotics for caesarean delivery, endometritis used to be a major cause of postpartum infection. Diagnosis can be difficult as the physiological changes of pregnancy can overlap significantly with the pathophysiology of sepsis. The clinician must often rely on a high index of clinical suspicion rather than objective criteria. Women at risk of infection should be identified early in pregnancy. Management of the septic pregnant patient must encompass resuscitation, identification, and treatment of the source of sepsis and management of complications such as hypotension and tissue hypoxia. The Royal College of Obstetricians and Gynaecologists recommend that sepsis should be managed in accordance with the Surviving Sepsis Campaign guidelines. Anaesthetists have broad experience in all the elements required to care for a sick parturient and obstetric anaesthetists are key members of the team required to successfully manage these women.

scholarly journals Urological issues in pregnancy: A review for urologists

2020 ◽  
Vol 14 (10) ◽  
Author(s):  
Joshua White ◽  
Jesse Ory ◽  
Andrea G. Lantz Powers ◽  
Michael Ordon ◽  
Jamie Kroft ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Surgical Procedures ◽  
Multidisciplinary Approach ◽  
Pregnant Patient ◽  
Placenta Percreta ◽  
Physiological Changes ◽  
Clinical Dilemma ◽  
Tract Infections ◽  
In Pregnancy

Urological issues in the pregnant patient present a unique clinical dilemma. These patients may be challenging to treat due to risks associated with medications and surgical procedures. This review aims to provide an update on the physiological changes and surgical risks in pregnancy. In addition, we review the approach for management of urolithiasis and urinary tract infections (UTIs) in pregnancy. Lastly, we highlight the importance of a multidisciplinary approach to placenta percreta, a condition not commonly addressed in urological education.

Renal disease

2020 ◽  
pp. 185-220
Author(s):  
Charlotte Frise ◽  
Sally Collins
Keyword(s):  
Chronic Kidney Disease ◽  
Blood Flow ◽  
Urinary Tract ◽  
Management Strategies ◽  
Pregnant Patient ◽  
Physiological Changes ◽  
Renal Size ◽  
Tract Infections ◽  
Increased Blood Flow ◽  
In Pregnancy

This chapter begins by describing the normal physiological changes that occur in pregnancy, including changes in tubular function, increased renal size, and increased blood flow. It then describes management strategies in a range of renal disorders, including haematuria, proteinuria, urinary tract infections, and both acute and chronic kidney disease. Hyperkalaemia, dialysis (and haemodialysis in pregnancy), transplantation, and medications suitable for use in the pregnant patient are all described, among others.

Pharmacokinetics, Placental and Breast Milk Transfer of Antiretroviral Drugs in Pregnant and Lactating Women Living with HIV

2019 ◽  
Vol 25 (5) ◽  
pp. 556-576 ◽  
Author(s):  
E.M. Hodel ◽  
C. Marzolini ◽  
C. Waitt ◽  
N. Rakhmanina
Keyword(s):  
Breast Milk ◽  
Protease Inhibitors ◽  
Drug Class ◽  
Drug Transporters ◽  
Maternal Plasma ◽  
Antiretroviral Drugs ◽  
Physiological Changes ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
In Pregnancy

Background:Remarkable progress has been achieved in the identification of HIV infection in pregnant women and in the prevention of vertical HIV transmission through maternal antiretroviral treatment (ART) and neonatal antiretroviral drug (ARV) prophylaxis in the last two decades. Millions of women globally are receiving combination ART throughout pregnancy and breastfeeding, periods associated with significant biological and physiological changes affecting the pharmacokinetics (PK) and pharmacodynamics (PD) of ARVs. The objective of this review was to summarize currently available knowledge on the PK of ARVs during pregnancy and transport of maternal ARVs through the placenta and into the breast milk. We also summarized main safety considerations for in utero and breast milk ARVs exposures in infants.Methods:We conducted a review of the pharmacological profiles of ARVs in pregnancy and during breastfeeding obtained from published clinical studies. Selected maternal PK studies used a relatively rich sampling approach at each ante- and postnatal sampling time point. For placental and breast milk transport of ARVs, we selected the studies that provided ratios of maternal to the cord (M:C) plasma and breast milk to maternal plasma (M:P) concentrations, respectively.Results:We provide an overview of the physiological changes during pregnancy and their effect on the PK parameters of ARVs by drug class in pregnancy, which were gathered from 45 published studies. The PK changes during pregnancy affect the dosing of several protease inhibitors during pregnancy and limit the use of several ARVs, including three single tablet regimens with integrase inhibitors or protease inhibitors co-formulated with cobicistat due to suboptimal exposures. We further analysed the currently available data on the mechanism of the transport of ARVs from maternal plasma across the placenta and into the breast milk and summarized the effect of pregnancy on placental and of breastfeeding on mammal gland drug transporters, as well as physicochemical properties, C:M and M:P ratios of individual ARVs by drug class. Finally, we discussed the major safety issues of fetal and infant exposure to maternal ARVs.Conclusions:Available pharmacological data provide evidence that physiological changes during pregnancy affect maternal, and consequently, fetal ARV exposure. Limited available data suggest that the expression of drug transporters may vary throughout pregnancy and breastfeeding thereby possibly impacting the amount of ARV crossing the placenta and secreted into the breast milk. The drug transporter’s role in the fetal/child exposure to maternal ARVs needs to be better understood. Our analysis underscores the need for more pharmacological studies with innovative study design, sparse PK sampling, improved study data reporting and PK modelling in pregnant and breastfeeding women living with HIV to optimize their treatment choices and maternal and child health outcomes.

424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A168-A168
Author(s):  
Mihaela Bazalakova ◽  
Abigail Wiedmer ◽  
Lauren Rice ◽  
Sakshi Bajaj ◽  
Natalie Jacobson ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Gestational Age ◽  
Retrospective Chart Review ◽  
Pregnant Patient ◽  
Clinic Visit ◽  
Early Screening ◽  
Home Sleep Apnea Testing ◽  
Living Children ◽  
Apnea Testing ◽  
In Pregnancy

Abstract Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None

scholarly journals Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy

2021 ◽  
Vol 81 (04) ◽  
pp. 390-397
Author(s):  
Maritta Kühnert ◽  
Sven Kehl ◽  
Ulrich Pecks ◽  
Ute Margaretha Schäfer-Graf ◽  
Tanja Groten ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis B ◽  
Task Force ◽  
Clinical Care ◽  
Diagnostic Procedures ◽  
Routine Clinical Care ◽  
Prenatal Counselling ◽  
Hepatitis Infection ◽  
Birth Planning ◽  
In Pregnancy

AbstractThese statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.

scholarly journals The Use of Bedside Ultrasound in the Evaluation of Patients Presenting with Signs and Symptoms of Pulmonary Embolism

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Adarsh N. Patel ◽  
L. Connor Nickels ◽  
F. Eike Flach ◽  
Giuliano De Portu ◽  
Latha Ganti
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Radiation Exposure ◽  
Computerized Tomography ◽  
Signs And Symptoms ◽  
Pregnant Patient ◽  
Poor Quality ◽  
Pulmonary Angiography ◽  
Bedside Ultrasound

Evaluation of patients that present to the emergency department with concerns for the diagnosis of pulmonary embolism can be difficult. Modalities including computerized tomography (CT) of the chest, pulmonary angiography, and ventilation perfusion scans can expose patients to large quantities of radiation especially if the study has to be repeated due to poor quality. This is particularly a concern in the pregnant population that has an increased incidence of pulmonary embolism and may not be able to undergo multiple radiographic studies due to fetal radiation exposure. This paper presents a case of a pregnant patient with signs and symptoms concerning pulmonary embolism. The paper discusses the use of bedside ultrasound in the evaluation of patients with pulmonary embolism.

scholarly journals Cardiopulmonary arrest in pregnancy with schizophrenia: a case report

2014 ◽  
Vol 7 (1) ◽  
pp. 821
Author(s):  
Takako Kudo ◽  
Akimune Kaga ◽  
Kozo Akagi ◽  
Hideki Iwahashi ◽  
Hiromitsu Makino ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiopulmonary Arrest ◽  
In Pregnancy

Renal disease in pregnancy

1989 ◽  
Vol 1 (2) ◽  
pp. 177-192 ◽  
Author(s):  
Priscilla Kincaid-Smith ◽  
Kenneth Fairley
Keyword(s):  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Intimate Relationship ◽  
Physiological Changes ◽  
Anatomical Changes ◽  
The Right ◽  
In Pregnancy

There is an intimate relationship between the kidney and pregnancy. Renal plasma flow increases by 50–70% during a normal pregnancy and the glomerular filtration rate by about 50%.1These changes commence in the first trimester and fall in the last trimester reaching normal levels within about four weeks postpartum. These physiological changes are accompanied by striking anatomical changes which consist of dilatation of the ureter, pelvis and calyces, together with an increase in renal parenchymal size. The dilatation i s more marked on the right and may appear in the first trimester. At term, 90% of pregnant women show this change.2

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