Critical Matters Critical Care In Pregnancy (Part 2) V1
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Jun 12, 2019 Dr. Stephen Lapinsky, a practicing intensivist and professor at the University of Toronto, delves into the unique critical care challenges faced by pregnant patients. He discusses the increased thromboembolic risks due to pregnancy-related coagulation changes and outlines diagnostic methods for conditions like DVT and PE. Lapinsky highlights the importance of tailored treatments, such as low-molecular-weight heparin, and emphasizes crucial airway management strategies. He also tackles the complexities of cardiac arrest management, providing insights on resuscitation techniques and the benefits of timely perimortem cesarean sections.
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Pregnancy Raises Thromboembolism Risk
- Pregnancy increases thromboembolic risk due to hypercoagulability, venous stasis, and local trauma from the uterus.
- Risk peaks postpartum and in the third trimester, and with bedrest or post-cesarean status.
Prefer Compression Ultrasound And V/Q First
- Use compression ultrasound first to diagnose DVT and avoid relying on Doppler respiratory changes.
- For suspected PE, start with a V/Q scan when chest x-ray is normal to limit maternal breast radiation, and use CTA if needed.
Use LMWH First; Thrombolysis Only With Caution
- Treat documented pregnancy-associated thrombosis with low molecular weight heparin as first-line therapy.
- Consider thrombolysis only in life-threatening PE and consult obstetrics because postpartum bleeding risk is the main concern.