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Chapter 29 - Endocrine disorders

from Section 4 - The pregnant patient with coexisting disease

Published online by Cambridge University Press:  05 July 2013

By
Patricia Peticca ,
Erin Keely  and
Tracey Johnston
Edited by
Marc van de Velde ,
Helen Scholefield  and
Lauren A. Plante
Marc van de Velde
Affiliation:
University Hospital Leuven
Helen Scholefield
Affiliation:
Liverpool Women's Hospital
Lauren A. Plante
Affiliation:
Drexel University College of Medicine
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Summary

There is little evidence base for pregnancy-specific management of endocrine crises, and in the majority of cases the underlying condition should be treated as it would be outside of pregnancy, with no need for immediate delivery. Thyroid storm is associated with an increased risk of preterm labor, and staff in the critical care setting should be aware of this, along with the signs and symptoms of labor. Myxedema coma is a challenge to diagnose because of its insidious onset and lack of classic signs and symptoms. Acute adrenal crisis in the pregnant patient, if left untreated, is associated with high risk of maternal and fetal mortality. If labor coincides with pituitary apoplexy, steroid administration and correction of electrolyte imbalances are essential. In pregnancy, diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) typically occur in the second and third trimesters, affecting an estimated 1-2 percentage of pregnancies.

Keywords

sedationpregnant patientremifentanilvolatile anestheticsmidazolamfentanylintensive care unitanalgesia
Type
Chapter
Information
Maternal Critical Care
A Multidisciplinary Approach
 , pp. 322 - 334
Publisher: Cambridge University Press
Print publication year: 2013

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