Use of neostigmine to relieve a suspected colonic pseudoobstruction in pregnancy.

Neostigmine is a treatment option for colonic pseudoobstruction. However, experience in using neostigmine for this indication in pregnant women is limited. We present a case of a woman with an estimated fetal gestational age of 34 weeks presented with what was believed to be a pseudoobstruction and when conservative management failed, neostigmine was administered with no adverse side effects. Ultimately, the patient was found to have a mechanical obstruction and we discuss the challenges in making this diagnosis in pregnancy. Neostigmine may be a viable alternative to colonoscopy in pregnant women for whom mechanical obstruction is properly excluded.

Use of the pulmonary artery catheter in severe preeclampsia: a review.

The use of a balloon-tipped, flow-directed pulmonary artery catheter in critically ill and surgical patients has become commonplace in the United States since its introduction into clinical medicine in 1970. The capability of acquiring continuous hemodynamic and, more recently, oxygen transport data, has led to an enhanced understanding of pathophysiologic processes in disease states and to an improved ability to guide therapeutic decision making. The purpose of this paper is to review experience with the pulmonary artery catheter in subsets of women with severe preeclampsia.

Base deficit and oxygen transport in severe preeclampsia.

OBJECTIVE: To evaluate the relationship of anaerobic metabolism, as reflected by the calculated base deficit, with oxygen transport and left ventricular function in women with severe preeclampsia. METHODS: Forty women with singleton pregnancies and severe preeclampsia who met prescribed criteria for invasive hemodynamic monitoring had arterial blood gas and hemodynamic values obtained immediately after placement of a pulmonary artery catheter. Oxygen transport indices were stratified according to the admission base deficit. RESULTS: Linear regression analysis demonstrated a strong negative correlation between the calculated base deficit and the oxygen delivery index (r = -0.64), cardiac index (r = -0.62), and left ventricular stroke work index (r = -0.58). A baseline maternal base deficit exceeding -8.0 mEq/L consistently predicted fetal acidosis, fetal death, and maternal end-organ ischemic injury. CONCLUSION: The calculated base deficit reliably reflects maternal oxygen transport dynamics and identifies patients at risk for end-organ injury. Ventricular contractility and oxygen delivery decline with mounting oxygen debt.

Adult respiratory distress in pregnancy: critical care issues.

Adult respiratory distress syndrome (ARDS) is a complex disease process involving noncardiogenic pulmonary edema, central hypovolemia, widespread atelectasis, and, in the final stages, an inability to perfuse end organs. Uteroplacental perfusion is usually compromised in such situations, which may be catastrophic, depending on the amount of fetal oxygen reserve. ARDS is often preceded by sepsis and frequently ends in maternal death, despite aggressive intervention. Inflammatory responses, complement activation, and prostaglandins have been implicated as probable mediators of both sepsis and ARDS. Invasive hemodynamic monitoring and mechanical ventilation are usually warranted to provide detailed assessment and support. However, when a critical illness affects the family unit, emotional and spiritual issues must receive significant attention to provide holistic care.

Critical care obstetrics: experts' round table discussion.

A panel of leading experts in critical care obstetric (CCOB) nursing met to discuss the specialty and its future, the impact of changes in the health care system, educational opportunities to learn and update CCOB nursing, formation and use of standards for the specialty, patient placement (dedicated obstetric intensive care units [OB ICU], labor and delivery intensive care units [L & D ICU], regular intensive care units [ICU]), patient populations, and interactions and working relationships with the physicians who care for CCOB patients (perinatologists, obstetricians, internists, obstetric medicine specialists, anesthesiologists, other subspecialists). The topics for discussion were chosen by Carol J. Harvey, RNC, MS, who acted as moderator and Mary Ellen Burke, RN, MS, coordinated the publication of the discussion.

Critical care obstetrics: the role of advanced practice nursing.

The role of the advanced practice nurse in the specialty of critical care obstetric nursing is emerging to meet the dynamic needs of health care under reform. Advanced practice components, including case management, research utilization, collaborative consultation, and advanced educational preparation, give light to a new model of caregiver. This article details the educational preparation and specific roles of the advanced practice nurse in the specialty of critical care obstetrics.

Principles in hemodynamic assessment.

Use of invasive hemodynamic monitoring provides more thorough assessment of hemodynamic function and may reveal abnormal data before the development of adverse clinical signs and symptoms. The obstetric nurse caring for critically ill patients is responsible for understanding the principles associated with hemodynamic monitoring and interpretation of data to better plan and implement nursing care.

Mechanical ventilation during pregnancy.

Mechanical ventilatory support is a significant component in the delivery of critical care. With increasing frequency, obstetric critical care nurses face the challenge of caring for women who require mechanical ventilation during pregnancy. It is important that those caring for such patients understand fundamental principles of mechanical ventilation, associated complications, and specific nursing care measures.

Trauma during pregnancy.

The active roles assumed by most pregnant women today put them at risk for vehicular accidents, falls, industrial accidents, violence, and other injuries. Trauma during pregnancy increases the maternal and fetal mortality and morbidity risks. Knowledge of the physiology of pregnancy is essential to establishing priorities and providing optimum care for the woman and fetus. Assessments and care from trauma and obstetric perspectives are essential; however, treatment priorities for the pregnant trauma patient are the primary consideration and are identical to those for nonpregnant trauma patients. Pregnancy does not limit or restrict any resuscitative, diagnostic, or pharmacologic treatment indicated after trauma. Fetal survival is dependent on maternal survival, so the woman must receive immediate intervention and condition stabilization for optimum fetal outcome.

Perinatal asphyxia: surveillance of the high-risk fetus.

Methods of testing to identify the fetus at risk for developing perinatal asphyxia continue to be developed and refined. The perinatal nurse needs to be knowledgeable of each test's purpose, capabilities, limitations, and clinical issues. Appropriate nursing interventions based on this knowledge facilitates the testing process and promotes the goal of improved perinatal outcome.