Critical Care Obstetrics, 4th edition by Gary A., III, MD Dildy, Michael A., MBBCH, MD, PhD Belfort,

By Gary A., III, MD Dildy, Michael A., MBBCH, MD, PhD Belfort, George R., MD Saade, Jeffrey P., MD, JD

The fourth variation of severe Care Obstetrics has been greatly revised to mirror the advances which were made in maternal-fetal drugs. This version comprises 14 fresh chapters written through the field's top physicians.Critical Care Obstetrics, 4/e, bargains elevated insurance in parts very important to in depth care administration, together with Neonatal Resuscitation, The Organ Transplant Obstetrical sufferer, and moral ConsiderationsThis functional consultant and reference can be of beneficial suggestions to obstetricians, and first care physicians, in either the remedy and referral of high-risk sufferers.

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Tertiary and nontertiary care facilities. Crit Care Med 1991;19 150-159. Task Force on Guidelines, Societyof Critical Medicine. Recommendations for critical care unit design. Crit Care Med 1988;16:796-806. Young RK, Weinstein HN, Katz M. Intrapartum maternal and fetal monitoring: the obstetrical intensive care unit. Int J Gynaecol Obsetet 1978;15(6):526-529. ll Pregnancy physiology 3 Pregnancy-induced physiologic alterations Errol R. Norwitz Julian N. Robinson Fergal D. Variablessuch as maternal age, multiple gestation, ethnicity,and genetic factors affect the ability of the mother to adapt to the demands of pregnancy.

Changes in the upper airways The elevated estrogen levels and increases in blood volume associated with pregnancy may contribute to mucosal edema and hypervascularity in the upper airways of the respiratory system. Theweightof evidencein theliteraturesuggests that such changes do lead to an increased prevalence of nasal stuffiness, rhinitis, and epistaxis during pregnancy. Epistaxis can be severe and recurrent. It has been reported to complicateup to 30%of pregnancies (Mabry,1986),although -since, in some cases, the condition likely predated the pregnancy -the incidence of rhinitis attributable to pregnancy is somewhat lower at around 18%(Mabry, 1986).

The net result of these two opposing mechanisms is an accumulation during CHAPTER pregnancy of approximately 500-900 mEq of sodium and 6-8L of total body water (Seitchik,1967; Lindheimer & Katz, 1973). There is also evidence to suggest that the fetus may contribute to the increase in maternal plasma volume. 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.

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