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Obstetrics and Critical Care

The following two articles are concise reviews of the general approach to the critically ill pregnant patient, and management of conditions encountered during the prenatal period, delivery, and puerperium.

Guntupalli KK, Hall N, Karnad DR, et al. Critical Illness in Pregnancy: part I: An Approach to a Pregnant Patient in the ICU and Common Obstetric Disorders. Chest 2015;148: 1093-104.
PMID: 26020613

Guntupalli KK, Karnad DR, Bandi V, et al. Critical Illness in Pregnancy: part II: Common Medical Conditions Complicating Pregnancy and Puerperium. Chest 2015;148:1333-45.  Review of medical conditions that affect pregnant women or that worsen during pregnancy.
PMID: 26020727

Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015;132:1747-73. A scientific update on guidelines and recommendations for all aspects of maternal resuscitation. They emphasize the use of BLS and ACLS as the foundation for any resuscitation, and focus on manual left uterine displacement, airway management, and perimortem cesarean delivery as areas of special attention.
PMID: 26443610
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WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. Lancet. 2017; 389:2105-116. This trial of over 20,000 women found tranexamic acid reduced the risk of death due to bleeding (1.5% vs 1.9%, p = 0.045). There was no difference in risk of hysterectomy or in the risk of adverse events, including thromboembolism.
PMID: 28456509
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Tolcher MC, McKinney JR, Eppes CS, et al. Prone positioning for pregnant women with hypoxemia due to coronavirus disease 2019 (COVID-19). Obstet Gynecol. 2020; 136:259-261. This review provides practical advice for placing pregnant patients in prone position. This includes links to instructional videos that are presumably applicable to other causes of severe hypoxemia.
PMID: 32516274

***See Leung et al in Pulmonary Embolism for information related to suspected pulmonary embolism in pregnancy.