Biomedical subjects

Carol A Curran

Publications and source records attributed to Carol A Curran.

5 recordsLinked to original sources

PubMed2005

Perianesthesia care following obstetric emergencies at risk for multisystem organ dysfunction.

Perianesthesia care provided to obstetric patients is on the rise due to current obstetric practice habits, changes in the maternal population, and the increased desire for scheduled childbirth. Both scheduled and emergent cesarean deliveries create risk, yet the use of general anesthesia increases maternal morbidity and mortality significantly. Obstetric emergencies make up the majority of emergent cesarean deliveries. Detrimental events during pregnancy and childbirth may be categorized into hemorrhagic, septic, or anaphylactic shock. Excessive loss of circulating volume with subsequent loss in oxygenation creates an environment for multisystem organ dysfunction syndrome (MODS). Both MODS and pregnancy are hyperdynamic and hypermetabolic states. Close monitoring is needed to differentiate pregnancy for the progression of organ dysfunction. Caring for pregnant women with the intent that pregnancy is a normal, physiologic state can lead to complacency and the risk of misdiagnosis. The purpose of this article is to review current obstetric emergencies that place the obstetric population at risk for MODS and offer management options to perianesthesia providers.

Anesthesia, General↗

PubMed2002

Multiple organ dysfunction syndrome (MODS) in the obstetric population.

Multiple organ dysfunction syndrome (MODS) has the potential to negatively affect obstetric outcomes of critically ill maternity patients. This pathophysiologic condition may often be indistinguishable from that which occurs during normal pregnancy. The normal adaptations of pregnancy, in their exaggerated form, may cause functional change to become dysfunctional in the maternal patient. Although pregnancy is considered a state of health, MODS is a grave condition with terminal outcomes. Regional perfusion deficits in oxygen and global defects of volume are two potential pathologic sequelae. Many general medical and obstetric causes may be identified. An exaggerated systemic inflammatory response syndrome (SIRS) precedes this patterned process of death. This article will apply current theories, assessment, and treatment practices of MODS to the obstetrical populace.

Disseminated Intravascular Coagulation↗

PubMedDate not supplied

A systematic approach to the physiologic adaptations of pregnancy.

When a woman learns that she is pregnant, her emotions are like a roller coaster. To her, she is pregnant. She begins to plan all the things that could be and is in constant motion to await the 9 months until the arrival of her bundle of joy. However, to those of us in the perinatal nursing field, it means so much more. The pregnant woman's body goes through some profound anatomical, physiologic, and biochemical changes to adapt to and support the entire pregnancy, which ultimately support the growing fetus. Although these physiologic changes are normal, often they can be misinterpreted as disease. These changes may also unmask or worsen a preexisting condition or disease, ultimately because the pregnant woman's body cannot adequately adapt to the changes of pregnancy. It is essential to know and understand the physiology-the inner workings-of both the mother and the fetus. This includes the basic adaptations related to pregnancy, placental physiology and action, uterine activity physiology, and fetal heart rate regulation, although this article will focus on maternal and uterine physiology only.

Adaptation, Physiological↗

PubMedDate not supplied

The effects of rhinitis, asthma, and acute respiratory distress syndrome as acute or chronic pulmonary conditions during pregnancy.

Pulmonary complications from both obstetrical and non-obstetrical causes contribute to a mortality rate as high as 80% in the pregnant population. The effect of numerous mechanical and biochemical physiologic alterations during pregnancy can influence the maternal and fetal outcomes in a woman with a pulmonary complication. Progesterone, the primary hormone of pregnancy, is a respiratory stimulant that enhances carbon dioxide release and alters the maternal pH in favor of releasing oxygen to the fetus. During systemic compromise, which may be experienced as an acute asthmatic attack or respiratory distress syndrome, desaturation and carbon dioxide retention ensue. Under these conditions, the fetus is at risk for perinatal hypoxemia. Although prompt recognition and treatment are important to minimize maternal, fetal, and neonatal morbidity and mortality, evidence-based literature regarding critical care techniques that promote optimal obstetrical outcomes is limited. Therefore, a collaborative approach to the care of these women is warranted. In addition to critical care, emergency medicine, and obstetrical nurses, the medical team may include an obstetrician, a perinatologist, a neonatologist, a pulmonologist, an intensivist, and an immunologist.

Acute Disease↗

PubMedDate not supplied

Intrapartum emergencies.

Intrapartum emergencies are challenging to all perinatal nurses because of the increased risk of adverse outcomes for the mother and fetus. Perinatal emergencies, such as seizures, amniotic fluid embolus, hemorrhage, and uterine rupture, create physiological challenges and trigger intrinsic survival techniques. The pregnant uterus becomes a vital source of blood volume during hypovolemic events because it is not considered a vital organ. The pregnancy itself may become burdensome, and birth may occur as an intrinsic maternal compensatory mechanism. The resultant fetal hypoxemia may also stress the fetus into initiating labor. During extensive oxygen desaturation and decompensation, the focus should be on maternal stabilization, which will subsequently enhance fetal stabilization. Clinical assessments, critical thinking, decision making, and resource allocation must be quick and appropriate to increase the likelihood of a positive outcome for the mother, fetus, and neonate.

Abruptio Placentae↗