Page 733 - ACCCN's Critical Care Nursing

Pregnancy and Postpartum

26 Considerations

Wendy Pollock
Clare Fitzpatrick

interaction with pregnancy and describes the major
Learning objectives obstetric conditions that are associated with critical
illness. Additionally, we include guidance on specific
After reading this chapter, you should be able to: practices relating to the care of pregnant and postpartum
l identify the core physiological adaptations of pregnancy women in ICU, for example assessment of fetal wellbeing
pertinent to critical care nursing and establishment of lactation. Further details on these
l describe the antenatal assessment that would be required topics can be found in textbooks that specifically deal
1,2
when caring for a woman 28 weeks pregnant in ICU with critical care obstetrics. Research into critical care
l describe the priorities of management for a postpartum obstetrics is limited and at times the evidence being
woman admitted to ICU with preeclampsia drawn on is dated, but still considered to be valid.
l outline the main causes of obstetric haemorrhage EPIDEMIOLOGY OF CRITICAL ILLNESS
l outline the standard postnatal care required by a woman in
ICU, for the 48 hours following birth IN PREGNANCY
l consider the resources and equipment available in your Most women experience a healthy, normal pregnancy and
workplace that are specifically required for the care of the development of critical illness associated with preg-
pregnant and postpartum women nancy is usually sudden and unexpected. Approximately
1 in 370 births result in a maternal ICU admission,
making up about 1% of the ICU population; more than
three-quarters of admissions occur following the birth of
the baby. Admission of a pregnant woman to ICU is
3,4
Key words infrequent and more likely to be related to a non-obstetric
diagnosis such as pneumonia or a motor vehicle crash.
Conversely, in postpartum women, a condition directly
critical illness in pregnancy associated with pregnancy is more likely, usually
severe maternal morbidity preeclampsia or obstetric haemorrhage. However, preg-
3
fetal wellbeing nant and postpartum women may be admitted to ICU
postpartum care with any diagnosis, which may or may not be associated
antenatal assessment with pregnancy.
severe preeclampsia
severe obstetric haemorrhage Pregnant and postpartum admissions to ICU are usually
short with most lengths of stay less than 24 hours. There
medical disorders in pregnancy is a vast variation in the threshold for admission to ICU
breastfeeding with one European study of severe maternal morbidity
reporting ICU admission proportions of between 0 and
5
50% across different regions. Additionally there are
many women who, when admitted to ICU, do not receive
INTRODUCTION any notable specific ICU intervention (Table 26.1) and
the need for ICU admission for these women has been
6
The admission of a pregnant or postpartum woman to questioned. In general, about a third of women who
ICU often extends ICU staff outside of their comfort experience severe maternal morbidity are admitted to
7
zone. Pregnant and postpartum women undergo substan- ICU. It is feasible that admission to ICU is preventable
6
tial physiological adaptations. Nursing staff also need to by upskilling midwifery services and by early identifica-
consider the fetus and be aware of, and manage, obstetric tion of severe illness resulting in prompt and appropriate
conditions. This chapter provides an overview of the epi- treatment. 6,8,9 There has been limited study of the long
demiology of critical illness in pregnancy, describes the term outcomes for pregnant and postpartum women
physiological adaptations of pregnancy and the puer- admitted to ICU in relation to their ongoing health and
710 perium, outlines some key medical conditions and their wellbeing, partner relationship and infant bonding. In