45. Obstetric Emergencies with Dr. Stephanie Levine and Dr. Adam Mora
Mar 24, 2025
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Dr. Stephanie Levine, a pulmonary expert and former president of Chest, teams up with Dr. Adam Mora, an intensivist focused on obstetric and transgender critical care. They dive into the high-stakes world of obstetric emergencies, discussing lifesaving strategies like resuscitative C-sections and managing postpartum hemorrhage. The conversation touches on physiological changes during pregnancy, the complexities of intubation, and the need for enhanced training in critical care. Together, they emphasize collaboration among specialists to improve outcomes for mothers and babies in crisis.
Timely resuscitative C-sections within five minutes significantly enhance CPR outcomes for pregnant patients in critical situations.
A multidisciplinary approach involving obstetricians and intensivists is essential for effectively managing complex obstetric emergencies in the ICU.
Socioeconomic factors and geographical disparities contribute significantly to higher maternal mortality rates, highlighting the need for improved access to specialized obstetric care.
Deep dives
Importance of Resuscitative C-Section
For pregnant individuals in crisis, particularly those around 24 weeks or at the level of the umbilicus, a resuscitative C-section is crucial for successful CPR outcomes. This procedure should be performed approximately within five minutes of recognizing the situation, as timely delivery helps relieve uterine compression and improves venous return. The decision to proceed with the C-section should ideally occur by the four-minute mark, since most OBs can extricate the baby swiftly thereafter. The improved blood flow gives rise to better chest compressions, greatly increasing the chances for both mother and child.
Navigating OB Emergencies
Handling obstetric emergencies requires a comprehensive understanding of the unique physiological changes during pregnancy and effective communication among multidisciplinary care teams. Practitioners must remain aware that maternal mortality rates remain disproportionately high in the U.S., especially in certain regions and demographic groups, indicating that access to specialized care is critical. A collaborative environment that incorporates obstetricians, intensivists, nurses, and specialists is vital for managing complex cases effectively. This collaboration must extend to analyzing the specific clinical presentation of each patient to tailor interventions appropriately.
Risk Factors and Health Disparities
Health risks associated with pregnancy are exacerbated by socioeconomic factors and geographical disparities, particularly in rural or underserved areas. The maternal mortality ratio is notably higher in the U.S. than in many developed countries, and it can vary significantly by state, with southern states showing higher rates. These alarming statistics highlight the need for improved healthcare access and specialized obstetric care to combat the increasing mortality in this population. Awareness of these disparities is crucial for practitioners to advocate for their patients and work to create systems that address these imbalances.
Physiological Changes During Pregnancy
Pregnancy induces significant physiological adaptations, particularly in the cardiovascular and respiratory systems, which healthcare providers must recognize to manage obstetrics patients effectively. Cardiac output increases substantially, contributing to lower systemic vascular resistance and blood pressure changes. The respiratory system also adapts, leading to higher minute ventilation and mild respiratory alkalosis that practitioners must consider when interpreting ABGs. Understanding these alterations enables healthcare providers to identify deviations from normality that could indicate potential emergencies like preeclampsia or eclampsia.
The Role of Simulations in Training
Simulation training plays an integral role in preparing medical professionals for rare obstetric emergencies, helping them practice coordinated responses in a safe environment. These realistic scenarios enable healthcare teams to identify potential issues with equipment access or communication gaps, allowing them to address these logistical challenges ahead of time. By engaging in these dynamic simulations, providers can improve their performance during actual life-or-death situations, fostering teamwork and enhancing collective decision-making. This preparation is essential, as obstetric emergencies can arise suddenly and demand quick, effective responses.
Managing Postpartum Hemorrhage and HELP Syndrome
Postpartum hemorrhage remains a leading cause of maternal morbidity and often requires rapid intervention and collaboration among interdisciplinary teams. The classic presentation of HELP syndrome—a combination of hemolysis, elevated liver enzymes, and low platelet count—necessitates immediate delivery and supportive care. Management strategies include monitoring laboratory values, maintaining hemostasis, and preparing for potential complications such as liver hematomas or hepatic rupture. Awareness of the clinical signs and timely intervention is crucial to reducing the risks associated with these conditions and enhancing patient outcomes.
On Critical Care Time we are no strangers to topics that make us uncomfortable. There may be no topic in the world of critical care more stress provoking than OB emergencies! Now… We didn’t say we are tackling this alone! Join us as we explore the wide world obstetrics in the ICU with Drs. Stephanie Levine and Adam Mora! Together we review the physiologic changes in pregnancy, unique considerations when it comes to general ICU management of the OB patient and then we delve into some OB cases where we tackle things like postpartum hemorrhage, cardiac arrest and more! Give us a listen and let us know what you think!
