Obstetric Patient Hot Case

GENERAL APPROACH

• Illness requiring ICU admission
• Pregnancy + Baby
• Delivery – when or already done

INTRODUCTION

CUBICLE

• CTG
• presence of midwives

INFUSIONS

• PET: MgSO4, phenytoin, hydralazine, GTN
• pre-term labour: tocolytics, steroids
• thromboembolism: heparin
• bleeding: blood products, fluid boluses, TXA
• cardiogenic shock: inotropes

VENTILATOR

• mode
• level of oxygenation: high FiO2, PEEP (pulmonary oedema)
• bronchospastic ventilation: asthma
• remember normal PaCO2 = 27-32mmHg and pH 7.47
• if spontaneously breathing: expect increased TV, RR, MV and reduced ETCO2
• increased A-a gradient with normal compliance: PE

MONITOR

• PET: hypertension
• PE: high CVP
• fever: sepsis, SIRS, drug fever

EQUIPMENT

• bleeding: large bore IV access
• PET: invasive monitoring
• CTG: fetal well being
• uterine bleeding: angiocatheter sheath in femoral artery

QUESTION SPECIFIC EXAMINATION

• hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general:
-> cardiovascular:
-> respiratory:
-> abdominal: fundal height, presenting part, lie, liquor volume, Caesarian scar

• neurological: unconscious or conscious

• HELLP: bruising/ecchymoses/petechiae:
• fatty liver of pregnancy: jaundice
• lower limb DVT
• ovarian hyperstimulation syndrome: oedema, pleural effusions, ascites
• PET: reflex for Mg toxicity, ask whether patient had a seizure
• pregnancy: gestational age and progress, results of vaginal examination
• steroids given pre-delivery
• if mother already delivered, ask about health status of child

RELEVANT INVESTIGATIONS

• CTG: heart rate, decelerations
• fetal U/S

OPENING STATEMENT

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• Global statement
• Mother
• Pregnancy + Baby
• Complications
• How to progress from here