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Contemporary Reviews in Critical Care Medicine |

Critical Illness in PregnancyCritical Illness in Pregnancy: Part II: Part II: Common Medical Conditions Complicating Pregnancy and Puerperium

Kalpalatha K. Guntupalli, MD, FCCP; Dilip R. Karnad, MD; Venkata Bandi, MD, FCCP; Nicole Hall, MD; Michael Belfort, MBBCH, MD, PhD
Author and Funding Information

From the Section of Pulmonary, Critical Care, and Sleep Medicine (Drs Guntaupalli and Bandi), Department of Medicine, the Department of Obstetrics and Gynecology (Drs Hall and Belfort), the Department of Surgery (Dr Belfort), and the Department of Anesthesiology (Dr Belfort), Baylor College of Medicine, Houston, TX; the Department of Critical Care (Dr Karnad), Jupiter Hospital, Thane, India; and the Department of Obstetrics and Gynecology (Drs Hall and Belfort), Texas Children’s Hospital Pavilion for Women, Houston, TX.

CORRESPONDENCE TO: Kalpalatha K. Guntupalli, MD, FCCP, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030; e-mail: kkg@bcm.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1333-1345. doi:10.1378/chest.14-2365
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The first of this two-part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly affect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis. Pregnancy predisposes to VTE; D-dimer levels have low specificity in pregnancy. A ventilation-perfusion scan is preferred over CT pulmonary angiography in some situations to reduce radiation to the mother’s breasts. Low-molecular-weight or unfractionated heparins form the mainstay of treatment; vitamin K antagonists, oral factor Xa inhibitors, and direct thrombin inhibitors are not recommended in pregnancy. The physiologic hyperdynamic circulation in pregnancy worsens many cardiovascular disorders. It increases risk of pulmonary edema or arrhythmias in mitral stenosis, heart failure in pulmonary hypertension or aortic stenosis, aortic dissection in Marfan syndrome, or valve thrombosis in mechanical heart valves. Common neurologic problems in pregnancy include seizures, altered mental status, visual symptoms, and strokes. Other common conditions discussed are aspiration of gastric contents, OSA, thyroid disorders, diabetic ketoacidosis, and cardiopulmonary arrest in pregnancy. Studies confined to pregnant women are available for only a few of these conditions. We have, therefore, reviewed pregnancy-specific adjustments in the management of these disorders.


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