By Gary A., III, MD Dildy, Michael A., MBBCH, MD, PhD Belfort, George R., MD Saade, Jeffrey P., MD, JD
The fourth variation of serious Care Obstetrics has been largely revised to mirror the advances which have been made in maternal-fetal drugs. This version includes 14 fresh chapters written by way of the field's best physicians.Critical Care Obstetrics, 4/e, deals improved assurance in parts important to extensive care administration, together with Neonatal Resuscitation, The Organ Transplant Obstetrical sufferer, and moral ConsiderationsThis sensible consultant and reference may be of useful advice to obstetricians, and first care physicians, in either the therapy and referral of high-risk sufferers.
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Additional info for Critical Care Obstetrics, 4th edition
BP measurements can be affected by maternal positioning. 3)For the sake of consistency and standardization, all BP measurements in pregnancy should be taken with the patient in the sitting position. In a seriesof 70 pregnant women, Ginsberg and Duncan (1969)demonstrated Blood pressure Blood pressure (BP) is the product of cardiac output and SVR, and reflects the ability of the cardiovascular system to maintain perfusion to the various organ systems,including the fetoplacental unit. Maternal BP is influenced by several factors, including gestational age, measurement technique, and positioning.
Placental estrogens are known to promote aldosterone production by directly activating the renin-angiotensin system, and the capacity of the placenta to synthesize estrogens is dependent in large part on the availability of estrogen precursor (dehydroepiandrosterone) from the fetal adrenal. However, the fetus is not essential for the development of gestational hypervolemia,because it develops also in complete molar pregnancies (Pritchard,1965b). of pregnancy. Earlier reports suggested that an increase in BP of 130mmHg systolic or 115mmHg diastolicover first or early second trimester BP should be used to define hypertension; however, this concept is no longer valid since many women exhibit such changes in normal pregnancy (Villar & Sibai, 1989;ACOG, 1996).
CHAPTER 3 postpartum values)at 28-32 weeks of pregnancy, and was further elevated in the sitting position. Stroke volume increased early in pregnancy, with maximal values by 20-24 weeks (range, +21% to +33%),followed by a progressive decline to- - Supine "i 1 1 I 1 I I r stroke volume (mL) .............. \. 50 -24 28-32 Gestation 38-40 I5-8 weeks PP Fig. 7 Effect of posture on maternal hemodynamics. PP. postpartum. (Reproducedby permission from Ueland K, Metcalfe J. Circulatorychanges in pregnancy.