OBSTETRIC ANESTHESIA AND CRITICAL CARE

Women who become acutely ill during pregnancy, childbirth or the postpartum period should have immediate access to the same standard of critical care as other ill patients, provided by teams skilled in providing critical care to the acutely deteriorating obstetric patient. Modified early warning sys-tems for obstetric patients should include: Respiratory rate, oxygen saturation, heart rate, systolic, diastolic blood pressure, body temperature, urine output. Knowledge of anatomical and physiological changes during pregnancy allows for better monitoring of critically ill patients in the intensive care unit. Obstetric indications for intensive care can be divided into four main categories: preexisting diseases that worsen during pregnancy, high-risk conditions that arise during pregnancy, coincidental conditions unrelated to pregnancy, and pure obstetric complications. Disorders such as myasthenia gravis, cardiomyopathies, and pulmonary hypertension can worsen during pregnancy, leading to severe complications that may require intensive care. Additionally, high-risk conditions that emerge during pregnancy can pose substantial risks; infections like urinary tract infections and pneumonia, along with thromboembolic diseases such as deep venous thrombosis and pulmonary embolism, can endanger both maternal and fetal health. The need for mechanical ventilation in pregnant patients is similar to that in non-pregnant patients. However, due to increased oxygen consumption and the fact that the fetus cannot tolerate hypoxemia and acidosis, oxygenation targets for the pregnant patient should be a saturation of 95% or higher and a PaO2 above 70 mmHg. A PaCO2 level in the mother above 65 mmHg or respiratory alkalosis can lead to decreased fetal perfusion. The lethal triad for fetal death includes maternal hypotension, hypoxia, and anemia. The main goal of the circulation is to ensure adequate utero-placental circulation. Although an optimal blood pressure value has not been found for adequate circulation and utero-placental perfusion, the main goal is stated to be a mean arterial pressure of around 65 mmHg. There are studies indicating that when the systolic blood pressure drops below 80 mmHg, fetal hypoxia and bradycardia can develop. Total spinal anesthesia, which occurs during spinal anesthesia, due to overextension of local anesthetics, leading to severe hemodynamic instability and requiring emergency intervention. Local anesthetic toxicity and postdural puncture headache are other complications encountered during regional anesthesia. Due to changes in hormone balance and increased susceptibility to edema, pregnant patients are at a higher risk for difficult intubation.