The Brain of the Critically Ill Pregnant Woman

1st Edition - November 28, 2023
Editors: Javier Perez-Fernandez, Carlos Montufar, Jorge Hidalgo
Language: English
Hardback ISBN:
9 7 8 - 0 - 4 4 3 - 1 5 2 0 5 - 4
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 1 5 2 0 4 - 7

The Brain of the Critically Ill Pregnant Woman is a volume in the Critical Care in Obstetrics series. This novel reference educates physicians, nurses, and all allied healthcar… Read more

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The Brain of the Critically Ill Pregnant Woman is a volume in the Critical Care in Obstetrics series. This novel reference educates physicians, nurses, and all allied healthcare personnel on updates for caring for pregnant women with neurological compromise. The book's authors have gathered the best evidence-based material that is explicitly focused on severe neurological complications in pregnant patients and postpartum. Among the chapters, the book covers medical-surgical complications that any patient can present, such as head trauma and complications specific to pregnancy.

Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Acknowledgments
Section 1. Critical care
Chapter 1. Neurologic complications in the obstetric patient
General approach to neurologic complications in obstetric patient
Neurologic complications in obstetric patient
Section 2. Neurologic monitorings
Chapter 2. Intracranial pressure monitoring and pregnancy
Clinical vignette of intracranial pressure monitoring in nontraumatic injury
Conclusions
Chapter 3. Monitoring of cerebral oxygenation
Cerebral blood flow oxygen saturation monitoring
Comparative analysis
Future trends
Conclusion
Chapter 4. Neuromonitoring in critically ill pregnant patients
Clinical neurologic examination
Automated pupillometry
Neuroimaging
Electroencephalography
Evoked potentials
External ventricular drain
Intraparenchymal monitors
Conclusion
Chapter 5. Multinodal neuromonitoring
Intracranial pressure
Jugular venous oximetry
Which side should be monitored?
Catheter placement
Technical and methodologic limitations
Electroencephalography
Transcranial Doppler
Section 3. Imaging
Chapter 6. Computed tomography findings in critical neurological conditions in the obstetric patient
Tomographic signs of intracranial hemorrhage
Tomographic signs of edema
Vascular-related cerebral pathologies in pregnancy
Nonvascular disorders
Chapter 7. Cerebral angiography and neurovascular intervention: General considerations specific to cerebral angiography and neurovascular intervention in pregnant patients
Stroke
Angiographic findings
Neurointerventional therapy
Angiographic findings
Neurointerventional therapy
Interventional techniques
Angiographic findings
Neurointerventional therapy
Angiographic findings
Neurointerventional therapy
Angiographic findings
Neurointerventional therapy
Angiographic findings
Interventional therapy
Chapter 8. Transcranial Doppler in pregnancy
Introduction
Transcranial Doppler
Cerebral hemodynamics during pregnancy
Transcranial Doppler uses in pregnant women
Transcranial Doppler in preeclampsia eclampsia
Postpartum angiopathy
Cerebral vein thrombosis
Ischemic and hemorrhagic complications
Conclusions
Section 4. Encephalopathy
Chapter 9. Hepatic encephalopathy during pregnancy
Introduction
Physiologic changes during pregnancy
Pathogenesis
Epidemiology of liver failure and hepatic encephalopathy in pregnancy
Clinical manifestations
Grading and classification
Diagnosis and laboratory testing
Hemodynamic and neurologic monitoring
Prognostic factors and liver transplantation
Chapter 10. Wernicke encephalopathy
Pathophysiology
Clinical features
Diagnosis
Management
Prevention
Section 5. Vascular disease
Chapter 11. Acute ischemic stroke
Introduction
Physiologic changes moderating the risk for ischemic stroke
Clinical manifestations
Diagnosis
Differential diagnosis
Management
Special consideration in pregnancy-associated stroke
Final word
Chapter 12. General approach to neurocritical care in obstetrics: The brain of the critically ill pregnant woman
Hemodynamic changes in pregnancy
Cerebrovascular disorders associated with pregnancy
Autoimmune disorders
Neurologic disorders
Chapter 13. Thrombotic thrombocytopenic purpura
Introduction
Epidemiology
Physiopathology
Clinical manifestations
Differential diagnosis
Diagnosis
Treatment
Monitoring of subsequent pregnancies
Conclusion
Chapter 14. Venous sinus thrombosis and pregnancy
Introduction
Clinical manifestations
Diagnosis
Treatment
Conclusions
Section 6. Neurological disease
Chapter 15. Headache in pregnancy
Introduction
Clinical presentation of most prevalent headaches in pregnancy
Primary headaches
Secondary headaches
Diagnostic approach
Chapter 16. Coma and brain death in pregnancy
Coma
Chapter 17. Eclampsia
Definitions and epidemiology
Pathophysiology
Cerebral maternal complications
Neurodiagnostic tests
Reversibility of cerebral lesions: Prognosis
Neurologic pathology in autopsies
Chapter 18. Central nervous system (CNS) infections in pregnancy
Viruses
Herpes encephalitis in the pregnant woman
Neonatal herpes
Treatment and prevention
Maternal signs and symptoms
Congenital varicella
Treatment
Maternal signs and symptoms
Diagnosis
Treatment
Maternal signs and symptoms
Congenital Zika syndrome
Treatment and prevention
Coronavirus disease 2019
Bacteria
Signs and symptoms
Prenatal diagnosis
Treatment and prevention
Treatment
Parasitic infections
Diagnosis
Section 7. Weakness syndromes
Chapter 19. Myasthenia gravis and pregnancy
Introduction
Epidemiology
Special considerations in pregnancy
Diagnosis
Treatment of myasthenia during pregnancy
Prenatal care considerations
Delivery
Puerperium
Chapter 20. Multiple sclerosis and pregnancy
Definition
Special considerations in pregnancy
Management and treatment
Chapter 21. Guillain-Barré syndrome in pregnancy
Clinical vignette
Incidence
Clinical features
Etiology and immunopathogenesis
Diagnosis
First trimester
Second and third trimesters and postpartum
Mode of delivery
Mode of anesthesia
Management
Specific treatment
Intravenous immunoglobulin
Safety and concerns with plasma exchange
Complications of Guillain-Barré syndrome
Section 8. Trauma
Chapter 22. Traumatic brain injury in critically ill pregnant women
Introduction
Physiologic changes in pregnancy
Neuromonitoring of pregnant women with traumatic brain injury
Radiologic examinations in pregnant women with traumatic brain injury
Initial resuscitation
Further monitoring of pregnant woman with traumatic brain injury
Specific management of traumatic brain injury in a pregnant woman
Obstetric management of pregnant women with traumatic brain injury
Gestational age and pregnant women with traumatic brain injury outcome
Outcome of pregnant women with traumatic brain injury
Conclusion
Chapter 23. Spinal trauma
Case study
Introduction
Epidemiology of spinal trauma
Primary and secundary injury
Neurologic assessment
Immobilization in acute trauma
Airway in spinal cord injury
Imaging studies
Acute management
Steroids in spinal trauma
Surgical management
Neurologic outcome
Section 9. Neurosurgery in pregnant woman
Chapter 24. Intracranial surgery
Introduction
Physiologic changes during pregnancy
Signs and symptoms of intracranial lesions
Possible brain pathology during pregnancy that requires surgery
Intracranial surgery: Preparation
Positioning of pregnant patient for intracranial surgery
Intracranial surgery: Intraoperative adjunct
Safety of preoperative and postoperative imaging during pregnancy, and postoperative management
Final discussion and conclusions
Section 10. Brain implications in cardiac arrest
Chapter 25. Cerebral resuscitation from cardiac arrest
Introduction
Epidemiology
Causes
Pathophysiology
Treatment
Cardiopulmonary resuscitation in pregnancy
Maternofetal neuroprotection
Postcardiac arrest neuromonitoring
Prognostic evaluation
Clinical approach
Conclusions
Section 11. The fetus
Chapter 26. Fetal surveillance in the neurocritical pregnant patient
Introduction
Section 12. Airway and mechanical ventilation
Chapter 27. Mechanical ventilation in the brain-injured pregnant woman
Acute respiratory distress syndrome in neurocritical obstetric patients
Other acute respiratory distress syndrome therapeutics
Weaning
Abbreviations
Chapter 28. Remote neurocritical monitoring of the critically ill pregnant patient
Introduction
Remote care: Brief overview of technology
Legacy steps to build a smart-intensive care unit/ emergency department (ED)
Requirements for remote care in high-acuity settings
Remote care: Operations and workflow
Current gaps in neurocritical care and high-risk maternity
Consent and privacy
Neuromonitoring
Remote neuromonitoring in specific pathologic states during pregnancy
Remote fetal monitoring
Outcomes
Chapter 29. Highly contagious central nervous system infectious
Viruses
Index

Javier Perez-Fernandez

Dr. Javier Perez-Fernandez serves as Medical Director of the Critical Care Services at Baptist Hospital of Miami. He is a Clinical Associate Professor of Medicine at Florida International University, Herbert Wertheim College of Medicine and Professor Pulmonary and Critical Care Medicine at Larkin University, Miami-Dade Florida. He is the Secretary-General of the World Federation of Intensive Care. Dr. Perez-Fernandez manages a large group of critical care physicians, South Florida Critical Care Services, overseeing the operations of seven ICUs with over 350 beds. He has been a regional and national recognized leader during the COVID-19 pandemic with multiple TV and media appearances and consulting services for several national and international organizations. He has been directly involved in the development of Rapid Response Teams, technology implementation and “open ICU” models. He has lectured worldwide and author of many original publications with the Society of Critical Care Medicine.

Affiliations and expertise

Medical Director, Critical Care Services Baptist Hospital of Miami, Florida, USA

Carlos Montufar

Dr. Carlos Montufar is the Head of the Obstetrics Intensive Care Unit of the "Dr. Arnulfo Arias M." Hospital Complex in Panama City, Panama. He is the creator and National Director of the Fellowship Program in Critical Care Obstetrics in Panama. He has written chapters in different texts on the subject of obstetric complications and obstetric intensive care. In addition, he has participated in clinical research studies, publishing papers in different International Medical Journals. Dr. Montufar had an important participation in the creation and structuring of the Fundamental Critical Care Support: Obstetrics course, endorsed by the Society of Critical Care Medicine (SCCM). He is a member of SCCM, and is designated as the International Ambassador of Society of Maternal Fetal Medicine (SMFM). Dr. Montufar has participated in countless international conferences as an exhibitor from 1997 to date.

Affiliations and expertise

Head of the Obstetrics Intensive Care Unit, Dr. Arnulfo Arias M Hospital Complex, Panama City, Panama

Jorge Hidalgo

Dr. Jorge Hidalgo is a Professor of Critical Care and the Head of the Division of Critical Care at Karl Heusner Memorial Hospital in Belize, Central America. He is the President Elect of the World Federation of Societies of Critical Care and Intensive Care Medicine. He has won several awards with the highest recognition and the Director of the very prestigious ACP Review Course hosted by the Paraguay Society of Internal Medicine. Due to his outstanding contribution to the Society of Critical Care Medicine he received the Presidential Citation Award. And Global Safar Award, becoming the First Latin American Intensivist to get this Nomination. He is involved in numerous congresses and a well-recognized international speaker.

Affiliations and expertise

Professor and Head, Division of Critical care, Karl Heusner Memorial Hospital, Belize, Central America