الفهرس 
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Abstract
Pregnancy is a normal physiological process that is defined by the
presence of utero-placental complex. Physiological changes associated
with pregnancy may result in strain on organ system with limited reserve
and resulting in deterioration of pre-existing medical condition so it is
important to know this physiologic adaptation which include changes in
cardiovascular system, respiratory system, renal changes, hematological
changes, metabolic changes, skin changes, GIT changes and Hormonal
changes.
The pregnant female may be admitted to the intensive care unit
because of diseases that occur only in pregnancy as pre-eclampsia, acute
fatty liver in pregnancy, amniotic fluid embolism and HEELP syndrome
or diseases worsened by pregnancy resulting in critical illness as deep
venous thrombosis. Although fewer than 1% of women require
admission to the intensive care unit but maternal and fetal mortality are
high when such care is required.
Most of obstetric patients admitted to the intensive care unit are
postpartum. The most common cause of admission are postpartum
hemorrhage and hypertensive disorders. Post partum hemorrhage is
defined by loss of greater than 500 ml of blood following vaginal
delivery or 1000 ml of blood after cesarean section. Preeclampsia is a
combination of both hypertension and proteinuria with onset of
symptoms in the late second or third trimester which need close
observation and good management to avoid eclamsia which is life
threating condition. Also HEELP syndrome which is defined by
hemolysis, elevated liver enzymes and low platelet count can occur in
pregnant patient and need supportive treatment also amniotic fluid
embolism and acute fatty liver of pregnancy can occur in pregnancy
which cause a critical condition to the pregnant femal with early
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Summary
identification and proper management to avoid maternal mortality.
Venous thromboembolic disease is considered one of the leading
cause of maternal mortality in which there increase in pregnancy due to
normal increase in prothrombotic factors, protein C and protein S with
proper treatment with anti-coagulant to avoid critically pulmonary
embolism. Cardiovascular diseases complicate 1-4% of pregnancies,
pregnant patients may have an underlying cardiac disease that may
become decompansated during pregnancy or may develop an occult
illness that is associated with pregnancy itself. Patients with valvular
heart disease may decompensate due to the physiologic changes that
occur during pregnancy and may develop pulmonary edema, other risk
factors for developing pulmonary edema in pregnant female are preeclampsia,
congenital heart disease, cardiomyopathy, sepsis, pulmonary
embolism and the tocolytic agent. Peripartum cardiomyopathy is an
idiopathic heart failure occurring in the abscence of any determinable
heart disease during the last month of pregnancy or the first 5 months
postpartum, the cause of the disease may be a combination of
environmental and genetic factor with recovery of most patients within
3-6 months of disease onset.
Approximately 20-30% of pregnant patients have non obstetric
cause for intensive care unit admission such as sepsis with need early
goal directed therapy with starting of broad spectrum antibiotic within 1
hour of the diagnosis of septic shock.
Successful management of the critically ill obstetric patient require
an awareness of the normal physiologic changes recognition of the
severity of the patient condition followed by admission to reduce
mortality and morbidity.