Maryland CC Project Anders – Critical Care for Two: When Pregnancy Meets the ICU
Jan 23, 2014
Dr. Megan Graybill Anders, an anesthesiologist and critical care expert, shares invaluable insights on managing critically ill pregnant patients. She discusses the physiological changes during pregnancy that impact ICU care, including respiratory adaptations and increased cardiovascular demands. Anders emphasizes the significance of fetal monitoring as an early warning system and outlines the importance of recognizing sepsis. She also explains perimortem cesarean delivery techniques and the need for organized team drills during maternal emergencies.
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Monitor Fetus And Coordinate With Obstetrics
- Start fetal and uterine monitoring after ~20 weeks to detect contractions, abruption, or fetal distress and consult obstetrics early.
- If fetal heart tracing worsens, perform in‑utero resuscitation: oxygen, IV fluids, and full lateral tilt while discussing delivery criteria with OB.
Pregnancy Masks Early Sepsis
- Pregnancy causes physiologic changes that can mask early sepsis signs like tachycardia, tachypnea, and leukocytosis.
- Pregnant patients compensate well and can deteriorate suddenly, so treat suspected sepsis promptly.
Manage Preeclampsia With Caution
- Treat preeclampsia by controlling severe hypertension and giving magnesium sulfate for seizure prophylaxis while anticipating renal dysfunction and magnesium toxicity.
- Remember preeclampsia patients are hypertensive but intravascularly hypovolemic; correct fluids cautiously and avoid overshoot when lowering BP.