SCCM Resource Library-Perioperative Intensive Care of the High-Risk Obstetric Patient

Video Transcription

Video Summary

Dr. Emily Naum, a dual-trained critical care physician and obstetric anesthesiologist at Massachusetts General Hospital, discusses the perioperative intensive care of high-risk obstetrics patients. She delves into the current trends in maternal morbidity and mortality, ICU admission characteristics, pregnancy physiology, and potential nontraditional critical care administration models. <br /><br />Dr. Naum highlights that severe maternal morbidity, defined by CDC as unexpected outcomes resulting in significant short- or long-term consequences, has increased by almost 200% since 1993. Blood transfusions have been the primary driver, but even when excluding them, severe maternal morbidity has risen by 20%. Risk factors contributing to complications include chronic heart, liver, and renal diseases, preeclampsia with severe features, multiple gestation, and prior cesarean delivery.<br /><br />Furthermore, racial and ethnic disparities persist in maternal morbidity and mortality, with non-Hispanic black women being particularly affected. The leading cause of maternal deaths in the U.S. is cardiovascular conditions, followed by pre-existing illnesses, sepsis, and hemorrhage. Maternal sepsis remains a concern with a constant 12% mortality rate over the past three decades. <br /><br />Dr. Naum emphasizes the importance of early detection and management of critical illness in pregnant patients, highlighting the use of scoring systems developed specifically for obstetric patients. These scoring systems, such as the Maternal Early Warning Criteria (MEW), help standardize evaluation and intervention in at-risk or deteriorating patients. Additionally, she discusses the potential benefits of graduated escalation of critical care delivery and the significance of emotional attachment and maternal-fetal bonding. <br /><br />Overall, Dr. Naum stresses the necessity of preconception counseling, risk assessment, continuous monitoring, prompt treatment, and multidisciplinary involvement in improving maternal critical care outcomes.

Asset Subtitle

Obstetrics, 2022

Asset Caption

This year-in-review session will consist of three parts. First will be an overview of high-impact perioperative intensive care medicine articles from the past year. Next will be two perspectives on perioperative intensive care in specific settings (liver transplantation and high-risk obstetrics).

Meta Tag

Content Type Presentation

Knowledge Area Obstetrics

Knowledge Level Advanced

Membership Level Select

Tag Obstetrics

Year 2022

Keywords

perioperative intensive care

maternal morbidity and mortality

severe maternal morbidity

racial and ethnic disparities

Maternal Early Warning Criteria (MEW)

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