Critical Care Scenarios Episode 87: Maternal-fetal monitoring with Stephanie Martin
Apr 30, 2025
In this engaging discussion, Stephanie Martin, an MFM obstetrician and co-owner of Clinical Concepts and Obstetrics, dives into the complexities of maternal-fetal monitoring in critically ill pregnant patients. She highlights the unique challenges faced in ICU settings, emphasizing interdisciplinary collaboration and the delicate balance of maternal and fetal health. Listeners learn key techniques for assessing fetal well-being, the significance of clear communication, and the intricacies of managing high-risk pregnancies, all delivered with insightful anecdotes and expert advice.
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Viability Guides Monitoring Decisions
- Viability around 23 to 24 weeks gestation guides monitoring and intervention decisions for the fetus.
- The fetal heart rate monitor reflects brain maturity, making early gestation monitoring more challenging to interpret.
Prevent Aortocaval Compression
- Avoid letting pregnant ICU patients lie flat on their back due to uterine compression impacting cardiac output.
- Tilt the patient or elevate the head of the bed to maintain adequate blood flow and comfort.
Uterus as Early Distress Indicator
- The uterus is often the first organ to show distress by shunting blood flow away under maternal shock.
- Changes in fetal heart rate and uterine contractions act as early warning signs of compromised fetal oxygenation.