Obstetric Disorders in the ICU

Daniela N. Vasquez; Lauren Plante; María N. Basualdo; Gustavo G. Plotnikow

doi:10.1055/s-0037-1600910

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2017; 38(02): 218-234
DOI: 10.1055/s-0037-1600910

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Obstetric Disorders in the ICU

Daniela N. Vasquez

¹Intensive Care Unit, Sanatorio Anchorena, Autonomous City of Buenos Aires, Argentina

,

Lauren Plante

²Departments of Anesthesiology and Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania

,

María N. Basualdo

³Department of Obstetrics and Gynecology, Sanatorio Anchorena, Autonomous City of Buenos Aires, Argentina

,

Gustavo G. Plotnikow

¹Intensive Care Unit, Sanatorio Anchorena, Autonomous City of Buenos Aires, Argentina

› Author Affiliations

Abstract

Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.

Keywords

obstetrics - critical care - preeclampsia - eclampsia - postpartum hemorrhage - septic abortion - puerperal infection

Full Text

References

References
1 Pollock W, Rose L, Dennis CL. Pregnant and postpartum admissions to the intensive care unit: a systematic review. Intensive Care Med 2010; 36 (9) 1465-1474
2 Vasquez DN, Estenssoro E, Canales HS , et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest 2007; 131 (3) 718-724
3 Vasquez DN, Das Neves AV, Vidal L , et al; ProPOC Study Group. Characteristics, outcomes, and predictability of critically ill obstetric patients: a multicenter prospective cohort study. Crit Care Med 2015; 43 (9) 1887-1897
4 Merali HS, Lipsitz S, Hevelone N , et al. Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childbirth 2014; 14: 280
5 Tranquilli AL, Dekker G, Magee L , et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens 2014; 4 (2) 97-104
6 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5) 1122-1131
7 Myatt L, Roberts JM. Preeclampsia: syndrome or disease?. Curr Hypertens Rep 2015; 17 (11) 83
8 WHO. Guideline: Calcium supplementation in pregnant women. Geneva: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/85120/1/9789241505376_eng.pdf . Accessed 2013
9 American College of Obstetricians and Gynecologists. Practice Advisory on Low-Dose Aspirin and Prevention of Preeclampia: Updated Recommendations. Washington, DC 2016 . Available at: http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Low-Dose-Aspirin-and-Prevention-of-Preeclampsia-Updated-Recommendations . Accessed April 27, 2017
10 U.S. Preventive Services Task Force. Final recommendation statement. Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality from Preeclampsia: Preventive Medication. Rockville, MD. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication . Accessed 2014
11 LeFevre ML ; U.S. Preventive Services Task Force. Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161 (11) 819-826
12 von Dadelszen P, Payne B, Li J , et al; PIERS Study Group. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet 2011; 377 (9761): 219-227
13 Thangaratinam S, Gallos ID, Meah N, Usman S, Ismail KM, Khan KS ; TIPPS (Tests in Prediction of Pre-eclampsia's Severity) Review Group. How accurate are maternal symptoms in predicting impending complications in women with preeclampsia? A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2011; 90 (6) 564-573
14 Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P ; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014; 36 (5) 416-441
15 Townsend R, O'Brien P, Khalil A. Current best practice in the management of hypertensive disorders in pregnancy. Integr Blood Press Control 2016; 9: 79-94
16 Nankali A, Malek-Khosravi Sh, Zangeneh M, Rezaei M, Hemati Z, Kohzadi M. Maternal complications associated with severe preeclampsia. J Obstet Gynaecol India 2013; 63 (2) 112-115
17 Vasquez DN, Das Neves AV, Zakalik G , et al; Argentinean CIOP Group. Hypertensive disease of pregnancy in the ICU: a multicenter study. J Matern Fetal Neonatal Med 2015; 28 (16) 1989-1995
18 Yücesoy G, Ozkan S, Bodur H , et al. Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center. Arch Gynecol Obstet 2005; 273 (1) 43-49
19 Zanette E, Parpinelli MA, Surita FG , et al; Brazilian Network for Surveillance of Severe Maternal Morbidity Group. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study. Reprod Health 2014; 11 (1) 4
20 Rojas-Suarez J, Vigil-De Gracia P. Pre-eclampsia-eclampsia admitted to critical care unit. J Matern Fetal Neonatal Med 2012; 25 (10) 2051-2054
21 Rojas-Arias JL, Ortiz-López LD, Orduña-Aparicio WJ , et al. Characterization of atypical preeclampsia. Fetal Diagn Ther 2015; 38 (2) 119-125
22 Noraihan MN, Sharda P, Jammal AB. Report of 50 cases of eclampsia. J Obstet Gynaecol Res 2005; 31 (4) 302-309
23 Martin Jr JN, Brewer JM, Wallace K , et al. HELLP syndrome and composite major maternal morbidity: importance of Mississippi classification system. J Matern Fetal Neonatal Med 2013; 26 (12) 1201-1206
24 Larsson A, Palm M, Hansson LO, Axelsson O. Reference values for clinical chemistry tests during normal pregnancy. BJOG 2008; 115 (7) 874-881
25 Yeomans ER, Gilstrap III LC. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005; 33 (10, Suppl): S256-S258
26 Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv 2012; 67 (4) 242-250
27 Crovetto F, Somigliana E, Peguero A, Figueras F. Stroke during pregnancy and pre-eclampsia. Curr Opin Obstet Gynecol 2013; 25 (6) 425-432
28 Scott CA, Bewley S, Rudd A , et al. Incidence, risk factors, management, and outcomes of stroke in pregnancy. Obstet Gynecol 2012; 120 (2 Pt 1): 318-324
29 Vigil-De Gracia P, Rojas-Suarez J, Ramos E , et al. Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America. Int J Gynaecol Obstet 2015; 129 (3) 219-222
30 Cantwell R, Clutton-Brock T, Cooper G , et al. Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl. 01) 1-203
31 American College of Obstetricians and Gynecologists. Committee Opinion no. 677. Antenatal corticosteroid therapy for fetal maturation 2016 . Available at: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Antenatal-Corticosteroid-Therapy-for-Fetal-Maturation . April 27, 2017
32 Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev 2010; (11) CD000025
33 Altman D, Carroli G, Duley L , et al; Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359 (9321): 1877-1890
34 McDonald SD, Lutsiv O, Dzaja N, Duley L. A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use. Int J Gynaecol Obstet 2012; 118 (2) 90-96
35 Bain ES, Middleton PF, Crowther CA. Maternal adverse effects of different antenatal magnesium sulphate regimens for improving maternal and infant outcomes: a systematic review. BMC Pregnancy Childbirth 2013; 13: 195
36 Smith JM, Lowe RF, Fullerton J, Currie SM, Harris L, Felker-Kantor E. An integrative review of the side effects related to the use of magnesium sulfate for pre-eclampsia and eclampsia management. BMC Pregnancy Childbirth 2013; 13: 34
37 Duley L, Matar HE, Almerie MQ, Hall DR. Alternative magnesium sulphate regimens for women with pre-eclampsia and eclampsia. Cochrane Database Syst Rev 2010; (8) CD007388
38 Pratt JJ, Niedle PS, Vogel JP , et al. Alternative regimens of magnesium sulfate for treatment of preeclampsia and eclampsia: a systematic review of non-randomized studies. Acta Obstet Gynecol Scand 2016; 95 (2) 144-156
39 Simon J, Gray A, Duley L ; Magpie Trial Collaborative Group. Cost-effectiveness of prophylactic magnesium sulphate for 9996 women with pre-eclampsia from 33 countries: economic evaluation of the Magpie Trial. BJOG 2006; 113 (2) 144-151
40 Gillon TE, Pels A, von Dadelszen P, MacDonell K, Magee LA. Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines. PLoS One 2014; 9 (12) e113715
41 Committee on Obstetric Practice. Committee Opinion No. 623: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol 2015; 125 (2) 521-525
42 Martin Jr JN, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol 2005; 105 (2) 246-254
43 Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 2013; (7) CD001449
44 Magee LA, von Dadelszen P. The management of severe hypertension. Semin Perinatol 2009; 33 (3) 138-142
45 NICE. National Institute for Health and Clinical Excellence. Hypertension in pregnancy: diagnosis and management. Clinical guideline. Published: 25 August 2010. Last updated January 2011. Available at: www.nice.org.uk/guidance/cg107 . Accessed April 27, 2017
46 Easterling TR. Pharmacological management of hypertension in pregnancy. Semin Perinatol 2014; 38 (8) 487-495
47 Brown CM, Garovic VD. Drug treatment of hypertension in pregnancy. Drugs 2014; 74 (3) 283-296
48 Vidaeff AC, Carroll MA, Ramin SM. Acute hypertensive emergencies in pregnancy. Crit Care Med 2005; 33 (10, Suppl): S307-S312
49 von Dadelszen P, Magee LA. Pre-eclampsia: an update. Curr Hypertens Rep 2014; 16 (8) 454
50 Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis. BJOG 2016; 123 (1) 40-47
51 Firoz T, Magee LA, MacDonell K , et al; Community Level Interventions for Pre-eclampsia (CLIP) Working Group. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review. BJOG 2014; 121 (10) 1210-1218 , discussion 1220
52 Magee LA, Miremadi S, Li J , et al. Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia. Am J Obstet Gynecol 2005; 193 (1) 153-163
53 McCoy S, Baldwin K. Pharmacotherapeutic options for the treatment of preeclampsia. Am J Health Syst Pharm 2009; 66 (4) 337-344
54 Bramham K, Nelson-Piercy C, Brown MJ, Chappell LC. Postpartum management of hypertension. BMJ 2013; 346: f894
55 Duley L, Williams J, Henderson-Smart DJ. Plasma volume expansion for treatment of women with pre-eclampsia. Cochrane Database Syst Rev 2000; (2) CD001805
56 Ganzevoort W, Rep A, Bonsel GJ, De Vries JI, Wolf H ; PETRA investigators. A randomized trial of plasma volume expansion in hypertensive disorders of pregnancy: influence on the pulsatility indices of the fetal umbilical artery and middle cerebral artery. Am J Obstet Gynecol 2005; 192 (1) 233-239
57 Lowe SA, Bowyer L, Lust K , et al. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55 (5) e1-e29
58 Anthony J, Schoeman LK. Fluid management in pre-eclampsia. Obstet Med 2013; 6 (3) 100-104
59 Brun C, Zieleskiewicz L, Textoris J , et al. Prediction of fluid responsiveness in severe preeclamptic patients with oliguria. Intensive Care Med 2013; 39 (4) 593-600
60 Langesæter E, Gibbs M, Dyer RA. The role of cardiac output monitoring in obstetric anesthesia. Curr Opin Anaesthesiol 2015; 28 (3) 247-253
61 Zieleskiewicz L, Contargyris C, Brun C , et al. Lung ultrasound predicts interstitial syndrome and hemodynamic profile in parturients with severe preeclampsia. Anesthesiology 2014; 120 (4) 906-914
62 Crozier TM, Wallace EM, Parkin WG. Haemodynamic assessment in pregnancy and pre-eclampsia: a Guytonian approach. Pregnancy Hypertens 2015; 5 (2) 177-181
63 Li YH, Novikova N. Pulmonary artery flow catheters for directing management in pre-eclampsia. Cochrane Database Syst Rev 2012; (6) CD008882
64 Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet 1995; 345 (8963): 1455-1463
65 Duley L, Gülmezoglu AM, Chou D. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev 2010; (9) CD002960
66 Duley L, Henderson-Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev 2010; (10) CD000128
67 Duley L, Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev 2010; (12) CD000127
68 Dusse LM, Alpoim PN, Silva JT, Rios DR, Brandão AH, Cabral AC. Revisiting HELLP syndrome. Clin Chim Acta 2015; 451 (Pt B): 117-120
69 Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev 2010; (9) CD008148
70 Say L, Chou D, Gemmill A , et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (6) e323-e333
71 Lombaard H, Pattinson RC. Common errors and remedies in managing postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2009; 23 (3) 317-326
72 Rath WH. Postpartum hemorrhage--update on problems of definitions and diagnosis. Acta Obstet Gynecol Scand 2011; 90 (5) 421-428
73 Charbit B, Mandelbrot L, Samain E , et al; PPH Study Group. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5 (2) 266-273
74 Cortet M, Deneux-Tharaux C, Dupont C , et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 2012; 108 (6) 984-989
75 Hunt BJ, Allard S, Keeling D, Norfolk D, Stanworth SJ, Pendry K ; British Committee for Standards in Haematology. A practical guideline for the haematological management of major haemorrhage. Br J Haematol 2015; 170 (6) 788-803
76 Abdul-Kadir R, McLintock C, Ducloy AS , et al. Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 2014; 54 (7) 1756-1768
77 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006; 108 (4) 1039-1047
78 Royal College of Obstetrician and Gynaecologists. Prevention and management of postpartum haemorrhage. Green-top guideline No. 52. April 2011. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gt52postpartumhaemorrhage0411.pdf . Accessed December 2016
79 Gayat E, Resche-Rigon M, Morel O , et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med 2011; 37 (11) 1816-1825
80 Cecconi M, De Backer D, Antonelli M , et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40 (12) 1795-1815
81 Jansen TC, van Bommel J, Schoonderbeek FJ , et al; LACTATE study group. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 2010; 182 (6) 752-761
82 Smith I, Kumar P, Molloy S , et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001; 27 (1) 74-83
83 Likis FE, Sathe NA, Morgans AK , et al. Management of postpartum hemorrhage. Comparative Effectiveness Review No. 151. Rockville, MD: Agency for Healthcare Research and Quality; 2015. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK294465/ . Accesses April 27, 2017
84 Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2013; (2) CD000567
85 Myburgh JA, Finfer S, Bellomo R , et al; CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012; 367 (20) 1901-1911
86 Annane D, Siami S, Jaber S , et al; CRISTAL Investigators. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA 2013; 310 (17) 1809-1817 (JAMA 2013;311(10):1071)
87 Reinhart K, Perner A, Sprung CL , et al; European Society of Intensive Care Medicine. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med 2012; 38 (3) 368-383
88 Perner A, Junttila E, Haney M , et al; Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Scandinavian clinical practice guideline on choice of fluid in resuscitation of critically ill patients with acute circulatory failure. Acta Anaesthesiol Scand 2015; 59 (3) 274-285
89 Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med 2013; 369 (25) 2462-2463
90 Chang R, Holcomb JB. Optimal fluid therapy for traumatic hemorrhagic shock. Crit Care Clin 2017; 33 (1) 15-36
91 Finfer S. Clinical controversies in the management of critically ill patients with severe sepsis: resuscitation fluids and glucose control. Virulence 2014; 5 (1) 200-205
92 Pasquier P, Gayat E, Rackelboom T , et al. An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage. Anesth Analg 2013; 116 (1) 155-161
93 Dahlke JD, Mendez-Figueroa H, Maggio L , et al. Prevention and management of postpartum hemorrhage: a comparison of 4 national guidelines. Am J Obstet Gynecol 2015; 213 (1) 76.e1-76.e10
94 Ekelund K, Hanke G, Stensballe J, Wikkelsøe A, Albrechtsen CK, Afshari A. Hemostatic resuscitation in postpartum hemorrhage - a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94 (7) 680-692
95 Wikkelsø AJ, Edwards HM, Afshari A , et al; FIB-PPH trial group. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth 2015; 114 (4) 623-633
96 McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 2012; 72 (5) 585-617
97 Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2015; (6) CD007872
98 Ducloy-Bouthors AS, Jude B, Duhamel A , et al; EXADELI Study Group. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011; 15 (2) R117
99 Lavigne-Lissalde G, Aya AG, Mercier FJ , et al. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J Thromb Haemost 2015; 13 (4) 520-529
100 Welsh A, McLintock C, Gatt S, Somerset D, Popham P, Ogle R. Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage. Aust N Z J Obstet Gynaecol 2008; 48 (1) 12-16
101 Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia 2012; 67 (1) 12-18
102 Paternina-Caicedo A, Miranda J, Bourjeily G , et al. Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Am J Obstet Gynecol 2017; 216 (1) 58.e1-58.e8
103 Georgiou C. Balloon tamponade in the management of postpartum haemorrhage: a review. BJOG 2009; 116 (6) 748-757
104 Mavrides E, Allard S, Chandraharan E , et al; on behalf of the Royal College of Physicians. Prevention and management of Postpartum hemorrhage. Green-top guideline No. 52. BJOG 2016; Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg52/ . Accessed April 2017
105 Seymour CW, Liu VX, Iwashyna TJ , et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8) 762-774
106 Shankar-Hari M, Phillips GS, Levy ML , et al; Sepsis Definitions Task Force. Developing a new definition and assessing new clinical criteria for septic shock. For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8) 775-787
107 Singer M, Deutschman CS, Seymour CW , et al; for the Sepsis Definitions Task Force. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (8) 801-810
108 Bone RC, Balk R, Cerra FB , et al, and members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20 (6) 864-874
109 Levy MM, Fink MP, Marshall JC , et al; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31 (4) 1250-1256
110 Bauer ME, Bauer ST, Rajala B , et al. Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (3) 535-541
111 Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K. Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens 2012; 30 (2) 342-350
112 The Global Maternal and Neonatal Sepsis Initiative Working Group. The Global Maternal and Neonatal Sepsis Initiative: a call for collaboration and action by 2030. Lancet Glob Health 2017. DOI: http://dx.doi.org/10.1016/S2214-109X(17)30020-7
113 Kramer HM, Schutte JM, Zwart JJ, Schuitemaker NW, Steegers EA, van Roosmalen J. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstet Gynecol Scand 2009; 88 (6) 647-653
114 Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellers S, Knight M ; United Kingdom Obstetric Surveillance System. Severe maternal sepsis in the UK, 2011-2012: a national case-control study. PLoS Med 2014; 11 (7) e1001672
115 Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg 2013; 117 (4) 944-950
116 Al-Ostad G, Kezouh A, Spence AR, Abenhaim HA. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: population-based study in the USA. J Obstet Gynaecol Res 2015; 41 (8) 1201-1206
117 Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. Am J Obstet Gynecol 2008; 199 (2) 133.e1-133.e8
118 Acosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A. The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PLoS One 2013; 8 (7) e67175
119 Dolea C, Stein C. Global Burden of Maternal Sepsis in the Year 2000. Geneva: Evidence and information for policy, World Health Organization; 2003. . Available at: http://www.who.int/healthinfo/statistics/bod_maternalsepsis.pdf . Accessed April 2017
120 Oud L, Watkins P. Evolving trends in the epidemiology, resource utilization, and outcomes of pregnancy-associated severe sepsis: a population-based cohort study. J Clin Med Res 2015; 7 (6) 400-416
121 Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS , et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9947): 980-1004
122 Eschenbach DA. Treating spontaneous and induced septic abortions. Obstet Gynecol 2015; 125 (5) 1042-1048
123 Rana A, Pradhan N, Gurung G, Singh M. Induced septic abortion: a major factor in maternal mortality and morbidity. J Obstet Gynaecol Res 2004; 30 (1) 3-8
124 Vasquez DN, Das Neves AV. Unsafe abortion: the silent endemic; an avoidable cause of maternal mortality. A review. Curr Womens Health Rev 2011; 7 (2) 151-163
125 Finkielman JD, De Feo FD, Heller PG, Afessa B. The clinical course of patients with septic abortion admitted to an intensive care unit. Intensive Care Med 2004; 30 (6) 1097-1102
126 Meites E, Zane S, Gould C ; C. sordellii Investigators. Fatal Clostridium sordellii infections after medical abortions. N Engl J Med 2010; 363 (14) 1382-1383
127 Fischer M, Bhatnagar J, Guarner J , et al. Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. N Engl J Med 2005; 353 (22) 2352-2360
128 Cohen AL, Bhatnagar J, Reagan S , et al. Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion. Obstet Gynecol 2007; 110 (5) 1027-1033
129 Lanari A, Firmat J, Paz RA, Rodo JE. [Septic abortion with acute renal insufficiency. Study of 150 cases]. Medicina (B Aires) 1973; 33 (4) 331-360
130 Cittadini F, Loyola G, Caradonna L, Minelli N, Rossi R. A case of toxic shock due to clandestine abortion by misoprostol self-administration. J Forensic Sci 2014; 59 (6) 1662-1664
131 Sutkin G, Capelle SD, Schlievert PM, Creinin MD. Toxic shock syndrome after laminaria insertion. Obstet Gynecol 2001; 98 (5 Pt 2): 959-961
132 Rahangdale L. Infectious complications of pregnancy termination. Clin Obstet Gynecol 2009; 52 (2) 198-204
133 Biriş M, Moldovan M, Păscuţ D, Motoc A. Utero-adnexal damage in septic abortion. Histopathological study on 91 cases. Rom J Morphol Embryol 2009; 50 (4) 657-662
134 Sama CB, Aminde LN, Angwafo III FF. Clandestine abortion causing uterine perforation and bowel infarction in a rural area: a case report and brief review. BMC Res Notes 2016; 9: 98
135 Shaikh Z, Abbassi RM, Rizwan N, Abbasi S. Morbidity and mortality due to unsafe abortion in Pakistan. Int J Gynaecol Obstet 2010; 110 (1) 47-49
136 Ngan Kee WD, Lee SW, Ng FF, Tan PE, Khaw KS. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology 2015; 122 (4) 736-745
137 Plante LA. Management of sepsis and septic shock for the obstetrician-gynecologist. Obstet Gynecol Clin North Am 2016; 43 (4) 659-678
138 Marik P, Bellomo R. A rational approach to fluid therapy in sepsis. Br J Anaesth 2016; 116 (3) 339-349
139 Lee CW, Kory PD, Arntfield RT. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound. J Crit Care 2016; 31 (1) 96-100
140 Stubblefield PG, Grimes DA. Septic abortion. N Engl J Med 1994; 331 (5) 310-314
141 Bacak SJ, Thornburg LL. Liver failure in pregnancy. Crit Care Clin 2016; 32 (1) 61-72
142 Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 2015; 36 (18) 1090-1097
143 Ersbøll AS, Damm P, Gustafsson F, Vejlstrup NG, Johansen M. Peripartum cardiomyopathy: a systematic literature review. Acta Obstet Gynecol Scand 2016; 95 (11) 1205-1219
144 Laliberte B, Reed BN, Ather A , et al. Safe and effective use of pharmacologic and device therapy for peripartum cardiomyopathy. Pharmacotherapy 2016; 36 (9) 955-970
145 LaRue S, Shanks A, Wang IW, Ewald G, Anderson D, Joseph S. Left ventricular assist device in pregnancy. Obstet Gynecol 2011; 118 (2 Pt 2): 426-428
146 Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol 2009; 201 (5) 445.e1-445.e13
147 Pantaleo G, Luigi N, Federica T, Paola S, Margherita N, Tahir M. Amniotic fluid embolism: review. Curr Pharm Biotechnol 2014; 14 (14) 1163-1167
148 Kobayashi H. Amniotic fluid embolism: anaphylactic reactions with idiosyncratic adverse response. Obstet Gynecol Surv 2015; 70 (8) 511-517
149 Shamshirsaz AA, Clark SL. Amniotic fluid embolism. Obstet Gynecol Clin North Am 2016; 43 (4) 779-790
150 Frati P, Foldes-Papp Z, Zaami S, Busardo FP. Amniotic fluid embolism: what level of scientific evidence can be drawn? A systematic review. Curr Pharm Biotechnol 2014; 14 (14) 1157-1162
151 Thongrong C, Kasemsiri P, Hofmann JP , et al. Amniotic fluid embolism. Int J Crit Illn Inj Sci 2013; 3 (1) 51-57
152 Clark SL. Amniotic fluid embolism. Obstet Gynecol 2014; 123 (2 Pt 1): 337-348
153 Ito F, Akasaka J, Koike N, Uekuri C, Shigemitsu A, Kobayashi H. Incidence, diagnosis and pathophysiology of amniotic fluid embolism. J Obstet Gynaecol 2014; 34 (7) 580-584
154 Busardò FP, Frati P, Zaami S, Fineschi V. Amniotic fluid embolism pathophysiology suggests the new diagnostic armamentarium: b-tryptase and complement fractions C3-C4 are the indispensable working tools. Int J Mol Sci 2015; 16 (3) 6557-6570
155 Fineschi V, Riezzo I, Cantatore S, Pomara C, Turillazzi E, Neri M. Complement C3a expression and tryptase degranulation as promising histopathological tests for diagnosing fatal amniotic fluid embolism. Virchows Arch 2009; 454 (3) 283-290
156 Kanayama N, Tamura N. Amniotic fluid embolism: pathophysiology and new strategies for management. J Obstet Gynaecol Res 2014; 40 (6) 1507-1517
157 Tamura N, Kimura S, Farhana M , et al. C1 esterase inhibitor activity in amniotic fluid embolism. Crit Care Med 2014; 42 (6) 1392-1396
158 Pacheco LD, Saade G, Hankins GD, Clark SL ; Society for Maternal-Fetal Medicine (SMFM). Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol 2016; 215 (2) B16-B24
159 Lavonas EJ, Drennan IR, Gabrielli A , et al. Part 10: special circumstances of resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132 (18) (Suppl. 02) S501-S518
160 Sultan P, Seligman K, Carvalho B. Amniotic fluid embolism: update and review. Curr Opin Anaesthesiol 2016; 29 (3) 288-296