CRITICALLY ILL WOMAN IN CHILDBEARING

Critically Ill Woman In Childbearing

Critically Ill Woman In Childbearing

Critically ill pregnant and postnatal women admitted to intensive care units (ICUs) require highly specialised care, components of which many critical care nurses are unfamiliar with. There are no specialist critical care obstetric centres in Australia, with critically ill obstetric patients admitted to general ICUs. There are no published guidelines and little research that assist critical care nurses to care for such women. Furthermore, the admission of pregnant or postnatal women to ICUs is likely to increase with emerging childbearing patterns in Australia. It is therefore timely to review what we know about caring for critically ill pregnant and postnatal women.

This paper analyses the literature on intensive care utilisation by obstetric patients and provides an overview regarding which pregnant and postpartum women require intensive care. The key areas of providing mechanical ventilation to pregnant women and assessment of fetal wellbeing are explored in detail. The most frequent conditions and their treatment, preeclampsia and obstetric haemorrhage, are also reviewed. The establishment of lactation is also considered as the critical care nurse is coruruonly involved in supporting the woruan's endeavour to breastfeed.

Introduction

The call comes in - a 39 year old woman has fitted as a result of preeclampsia and has had an emergency caesarean section. She is intubated and requires an intensive care unit (ICU) bed. Her baby was born at 29 weeks and is ventilated in the neonatal ICU (NICU). You look around the unit and think "Who's done Mid?".

You scan the unit for a second time... "Who's had a baby? Is there anyone on who knows about breasts and how to check a fundus?" The admission of a pregnant or postnatal woman to ICU therefore presents a unique set of challenges to critical care nurses, as this scenario highlights.

This paper has four components. The first is to impart a descriptive account of the pregnant and postnatal women who require ICU services. The second concerns aspects of care unique to the pregnant patient, including the provision of mechanical ventilation to pregnant women and fetal monitoring in the ICU. The third is to provide a synopsis about what is known about the treatment of the most common conditions that obstetric patients present to ICW with (namely preeclampsia and obstetric haemorrhage). Finally, the initiation of lactation (given that most women are admitted in the first 24 hours following delivery) is discussed. Since ruany critical care nurses are unfamiliar with midwifery practice, these key areas are first described prior to the critiquing of the available evidence for practice.

Despite the paucity of research on critically ill pregnant and postnatal women, there are fundamental areas worthy of critical review, as they are highly relevant for critical care nursing practice.

Relevant literature is spread across a diverse range of disciplines including obstetrics, neonatology, anaesthetics, intensive care medicine, other varied medical specialties, midwifery, critical care nursing and allied health and basic sciences.

It is beyond the scope of this paper to provide details on the extensive physiological changes that ...