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Journal articles on the topic 'Obstetric Crisis'

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Published: 4 June 2021
Last updated: 19 February 2022

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1

Dalby, Patricia L., and Gabriella Gosman. "Crisis Teams for Obstetric Patients." Critical Care Clinics 34, no. 2 (April 2018): 221–38. http://dx.doi.org/10.1016/j.ccc.2017.12.003.

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2

Miguel Ángel Ródenas Monteagudo, Odette Gutiérrez Pérez, Eva Romero García, and Pilar Argente Navarro. "Evaluación del trabajo en equipo en emergencias obstétricas, ¿contamos con las herramientas necesarias?" Revista Electrónica AnestesiaR 10, no. 11 (November 30, 2018): 5. http://dx.doi.org/10.30445/rear.v10i11.647.

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Las emergencias obstétricas son un escenario que aparece con relativa frecuencia. En los últimos años, diferentes trabajos orientan a que muchos eventos adversos en obstetricia se producen por un pobre trabajo en equipo durante las situaciones de crisis. Existen varias herramientas que evalúan las habilidades no técnicas de los equipos en estas situaciones. El objetivo de este trabajo fue valorar si estas herramientas son realmente válidas en el contexto obstétrico. ABSTRACT Obstetric emergencies are situations that appear relatively frequent. In the last years, some studies suggest that many adverse outcomes in obstetrics are produced by poor teamwork in emergencies. There are some assessment tools to evaluate the nontechnical skills of the teams in these situations. The purpose of this review was to find if these tools are valuable in obstetrics.
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3

Robertson, Bethany, Lori Schumacher, Gabriella Gosman, Ruth Kanfer, Maureen Kelley, and Michael DeVita. "Simulation-Based Crisis Team Training for Multidisciplinary Obstetric Providers." Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare 4, no. 2 (2009): 77–83. http://dx.doi.org/10.1097/sih.0b013e31819171cd.

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4

Simpson, Ellen, and Linda Daniel. "Obstetric Emergency Simulation Training: Team Training for Crisis Care Management." Journal of Obstetric, Gynecologic & Neonatal Nursing 39 (September 2010): S76—S77. http://dx.doi.org/10.1111/j.1552-6909.2010.01121_39.x.

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5

Dayal, Ashlesha K., Armin S. Razavi, Amir K. Jaffer, Nishant Prasad, and Daniel W. Skupski. "COVID-19 in obstetrics 2020: the experience at a New York City medical center." Journal of Perinatal Medicine 48, no. 9 (November 26, 2020): 892–99. http://dx.doi.org/10.1515/jpm-2020-0365.

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AbstractThe global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.
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6

Stephens, Angela J., John R. Barton, Nana-Ama Ankumah Bentum, Sean C. Blackwell, and Baha M. Sibai. "General Guidelines in the Management of an Obstetrical Patient on the Labor and Delivery Unit during the COVID-19 Pandemic." American Journal of Perinatology 37, no. 08 (April 28, 2020): 829–36. http://dx.doi.org/10.1055/s-0040-1710308.

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Novel coronavirus disease 2019 (COVID-19) is a respiratory tract infection that was first identified in China. Since its emergence in December 2019, the virus has rapidly spread, transcending geographic barriers. The World Health Organization and the Centers for Disease Control and Prevention have declared COVID-19 as a public health crisis. Data regarding COVID-19 in pregnancy is limited, consisting of case reports and small cohort studies. However, obstetric patients are not immune from the current COVID-19 pandemic, and obstetric care will inevitably be impacted by the current epidemic. As such, clinical protocols and practice on labor and delivery units must adapt to optimize the safety of patients and health care workers and to better conserve health care resources. In this commentary, we provide suggestions to meet these goals without impacting maternal or neonatal outcomes. Key Points • Novel coronavirus disease 2019 (COVID-19) is a pandemic.• COVID-19 impacts care of obstetric patients.• Health care should be adapted for the COVID-19 pandemic.
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7

Balki, Mrinalini, Mary Ellen Cooke, Susan Dunington, Aliya Salman, and Eric Goldszmidt. "Unanticipated Difficult Airway in Obstetric Patients." Anesthesiology 117, no. 4 (October 1, 2012): 883–97. http://dx.doi.org/10.1097/aln.0b013e31826903bd.

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Background The objective of this study was to develop a consensus-based algorithm for the management of the unanticipated difficult airway in obstetrics, and to use this algorithm for the assessment of anesthesia residents' performance during high-fidelity simulation. Methods An algorithm for unanticipated difficult airway in obstetrics, outlining the management of six generic clinical situations of "can and cannot ventilate" possibilities in three clinical contexts: elective cesarean section, emergency cesarean section for fetal distress, and emergency cesarean section for maternal distress, was used to create a critical skills checklist. The authors used four of these scenarios for high-fidelity simulation for residents. Their critical and crisis resource management skills were assessed independently by three raters using their checklist and the Ottawa Global rating scale. Results Sixteen residents participated. The checklist scores ranged from 64-80% and improved from scenario 1 to 4. Overall Global rating scale scores were marginal and not significantly different between scenarios. The intraclass correlation coefficient of 0.69 (95% CI: 0.58, 0.78) represents a good interrater reliability for the checklist. Multiple critical errors were identified, the most common being not calling for help or a difficult airway cart. Conclusions Aside from identifying common critical errors, the authors noted that the residents' performance was poorest in two of our scenarios: "fetal distress and cannot intubate, cannot ventilate" and "maternal distress and cannot intubate, but can ventilate." More teaching emphasis may be warranted to avoid commonly identified critical errors and to improve overall management. Our study also suggests a potential for experiential learning with successive simulations.
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8

D'Couth, Smitha, and Suneetha Kalam. "Fetomaternal outcome in sickle cell hemoglobinopathy in a tertiary care centre of North Kerala, India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 12 (November 23, 2017): 5299. http://dx.doi.org/10.18203/2320-1770.ijrcog20175232.

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Background: Pregnancy is a serious burden to women with sickle cell disease (SCD). Our centre is the only tertiary care referral centre in the public sector which caters to the districts of Wayanad and the Nilgiris which has the maximum prevalence for SCD in South India. Hence this study was conducted to assess complications in pregnancy and maternal and perinatal outcome among women with SCD.Methods: A retrospective observational study was conducted by reviewing the medical records of all the pregnant women with SCD who had delivered in the Department of Obstetrics and Gynecology, Government Medical College, Kozhikode from January 2014 to December 2016.Results: There were 72 antenatal women with SCD during the study period with a prevalence of 0.15%. 54.17% (n = 39) patients were HbSS (sickle cell anemia), 44.44% (n = 32) were HbAS (sickle cell trait) and 1.39% (n = 1) were HbS-β thalassemia trait. There was increased risk of obstetric complications like gestational hypertension (16%), preeclampsia (11.11%), eclampsia (5.56%), HELLP syndrome (4.16%), intrauterine growth retardation (38.89%), and oligohydramnios (18.06%). Medical complications observed were mainly anaemia (76.38%), vasoocclusive crisis (18.05%), acute chest syndrome (5.56%) and infections like urinary tract infection (8.33%) and pneumonia (5.56%). The incidence of low birth weight babies (56.94%), low Apgar score (14.49%) and neonatal ICU admissions (31.88%) were high. There was no maternal mortality, but perinatal mortality was high (6.94%).Conclusion: Pregnancy in SCD is associated with an increased maternal morbidity and high perinatal mortality due to obstetric and medical complications.
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9

Kost, Michael, Melissa Hewitt, Cindy Betron, and John M. O'Donnell. "An in-situ interprofessional simulation program to improve teamwork and obstetric crisis management skills." Journal of Interprofessional Education & Practice 16 (September 2019): 100264. http://dx.doi.org/10.1016/j.xjep.2019.100264.

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10

Ellison, Kendra, Michele Lynn Bierman, and Ivana Knitowski. "Let's TWIST (Teambuilding in Women's Health Incorporating Simulation Training): Implementing Obstetric Crisis Simulation Program." Journal of Obstetric, Gynecologic & Neonatal Nursing 41 (June 2012): S112. http://dx.doi.org/10.1111/j.1552-6909.2012.01361_88.x.

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11

Davis, Dána-Ain. "Reproducing while Black: The crisis of Black maternal health, obstetric racism and assisted reproductive technology." Reproductive Biomedicine & Society Online 11 (November 2020): 56–64. http://dx.doi.org/10.1016/j.rbms.2020.10.001.

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12

Prabawa, Aditya, and Ketut Surya Negara. "Diagnosis and Comprehensive Management of Thyroid Storm in Pregnancy: A Case Report." Biomedical and Pharmacology Journal 11, no. 3 (August 29, 2018): 1329–34. http://dx.doi.org/10.13005/bpj/1495.

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Thyroid crisis is an emergency in Endocrinology which is characterized by acute hypermetabolic with rapid deterioration which is one of non-obstetric maternal death cause. This condition is rare serious complication, affect about 1-2% of patients with hyperthyroidism. Unrecognized and untreated thyroid storm causing life threatening condition. Management of thyroid storm in pregnancy is aimed to reduce the synthesis and secretion of thyroid hormone and pregnancy management. Explain about optimal diagnostic and treatment strategies of pregnancy with thyroid storm. A 28 years woman admitted to Obstetrics Emergency Room, third pregnancy with 36 weeks 2 weeks gestation was complained of shortness of breath since 3 days ago. History of hyperthyroid since 1 year ago, often palpitate, sweating and tremor. History of consumption PTU 3x100 mg oral but lack of obey. History of hypertension since 27 weeks gestation. Physical examination found that blood pressure was 170/110 mmHg, pulse rate 130 bpm, respiratory rate bpm, 84% oxygen saturation, 38.5°C temperature. Diffuse tiroid gland was palpable with size 1 x 2 cm, ronkhi in whole lung field. Obstetric examination was found breech presentation with FHB: 131 bpm. Laboratory result were TSHs / FT4: 0.24 / 1.72, T4 Total: 104. Thyroid storm diagnostic based on Burch Wartofsky score: 55. Initial treatment performed with oxygen administration, loop diuretics, chest X-ray examination and echocardiography. Followed by PTU therapy, lugolization and corticosteroids. After 48 hours of stabilization, we performed cesarean section and postoperative care at Intensive Care Unit. Thyroid storm is rare pregnancy complication. Diagnostic criteria using Burch and Wartofsky score. Management of thyroid storm in pregnancy includes anti thyroid drugs, lugol solution, corticosteroids and pregnancy management. Diuretic therapy is given due to fluid overload, besides that screening of thyroid hormone profile is important during antenatal care.
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13

Markwei, Metabel, and Oluwatosin Goje. "Optimizing mother–baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine." Women's Health 17 (January 2021): 174550652110132. http://dx.doi.org/10.1177/17455065211013262.

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Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby. Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy. Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic. Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic. Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.
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Kaur, Brinderjeet. "Pragmatic approach to provide uninterrupted obstetric services amidst SARS COV-2 pandemic." International Journal of Pregnancy & Child Birth 6, no. 6 (2020): 143–46. http://dx.doi.org/10.15406/ipcb.2020.06.00213.

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The novel severe acute respiratory syndrome corona virus 2 (SARS COV-2) has taken our civilization by surprise. Eachpassing day emanate new set of issues, necessitating changes in its management. Its significance & impact on pregnant woman, pregnancy outcome has been detrimental as COVID-19 has been associated with maternal and perinatal morbidity and mortality in this set of vulnerable groups–pregnant women. The recommendations by ICMR need to be appreciated and efforts should be made at each level to simplify the assessment of COVID-19. We at a tertiary private setup followed methodology for triage and assessment for pregnant women ever since lock down measures was levied. The present paper discusses in brief the approach that was followed at our institute that helped us to provide services without fail during the crisis hour as well as minimizing the risk of infection to our doctors, resident doctors, nursing staff, support staff and health care workers in the team. This could provide valuable inputs to other institutes facing dearth of skilled man power as we all need to gear up for coming months as the pandemic is ongoing with no flattening of curve in near sight.
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15

Mahmood, Iftikher, Nrinmoy Biswas, Fahmida Akter, Johanna Hansing, Arman Mahmood, Ashley Pugh, Jessica Love, and Steven Arrowsmith. "Burden of Obstetric Fistula on the Rohingya Community in Cox's Bazar, Bangladesh." Nepal Journal of Obstetrics and Gynaecology 13, no. 2 (November 18, 2018): 47–51. http://dx.doi.org/10.3126/njog.v13i2.21715.

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Since August 2017, a massive influx of over 800,000 Rohingya refugees have arrived in Cox’s Bazar, Bangladesh. The Rohingya state is one the poorest states in Myanmar, with ghetto-like camps and a lack of basic services and opportunities. In 1982, a new citizenship law was passed, effectively rendering the Rohingya stateless. As a result of this law, their rights to access health services have been restricted. Now, many Rohingya are living in Cox’s Bazar in tent-based refugee camps under extremely poor conditions without access to proper medical care, hygiene, sanitation, food or education. Lack of proper maternal health care, together with early marriage, malnutrition, poverty and the physical characteristics of the women in this community (small body shapes), exposes Rohingya women to a very dangerous position with high chances of developing obstetric fistula during childbirth. HOPE Hospital provides clinical care for women affected with obstetric fistula and is the only provider and referral center of fistula care in the region. Since the influx began, many fistula repairs have been carried out on Rohingya women at HOPE Hospital. This paper looks at fistula care and the psychosocial impact of fistula on victims in the refugee population, amid a massive humanitarian crisis.
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Peraçoli, José Carlos, Vera Therezinha Medeiros Borges, José Geraldo Lopes Ramos, Ricardo de Carvalho Cavalli, Sérgio Hofmeister de Almeida Martins Costa, Leandro Gustavo de Oliveira, Francisco Lazaro Pereira de Souza, et al. "Pre-eclampsia/Eclampsia." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 41, no. 05 (May 2019): 318–32. http://dx.doi.org/10.1055/s-0039-1687859.

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AbstractPre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.
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17

Munyuzangabo, Mariella, Michelle F. Gaffey, Dina S. Khalifa, Daina Als, Anushka Ataullahjan, Mahdis Kamali, Reena P. Jain, et al. "Delivering maternal and neonatal health interventions in conflict settings: a systematic review." BMJ Global Health 5, Suppl 1 (February 2021): e003750. http://dx.doi.org/10.1136/bmjgh-2020-003750.

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BackgroundWhile much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings.MethodsWe searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken.Results115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited.DiscussionThe relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions.PROSPERO registration numberCRD42019125221.
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18

Usevych, I. A., and V. L. Kolesnik. "Influence of the category of urgency of the caesarean section on the adaptive capabilities of pregnant and parturient women." HEALTH OF WOMAN, no. 5(121) (June 30, 2017): 10–15. http://dx.doi.org/10.15574/hw.2017.121.10.

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Psychological problems during pregnancy and childbirth for today is a little studied subject of modern obstetrics. The possibilities for solving psychological problems that arise in cases of emergency obstetric situations are almost not used by Ukrainian specialists through the marriage of knowledge and skills to provide crisis psychological help to obstetric patients. The objective: to determine the level of psychoemotional load in pregnant and parturient women, depending on the category of urgency of cesarean section. Material and methods. The main group of the study was presented: 1 group - pregnant women, who had planned a cesarean section operation according to the ІV category of urgency and who had already had a caesarean section in the anamnesis; ІІ group – pregnant women who planned an operation according to the IV category of urgency and who had no previous caesarean section in their history; ІІІ group – pregnant and parturient women who underwent surgery, respectively, in the I–III category of urgency; Control group – 30 pregnant women in the period of 37–41 weeks of pregnancy. A survey was conducted using the questionnaires of J.Teylor, Ch.Spielberger and SAN-test. Results. On the eve of labor in pregnant women there is an increase in the psychoemotional load, which can be determined using the above questionnaires. There is a direct dependence on the category of urgency of cesarean section and the level of psychoemotional load. Also revealed the correlation dependence of the voltage of the adaptation reserves of the pregnant woman on the presence of a history of caesarean section. Conclusion. Almost 50 percent of pregnant women, in cases of cesarean section, respectively, 1–3 categories of urgency in the preoperative period have the maximum level of psychoemotional load according to the questionnaires used. Pregnant women who have undergone a caesarean section in anamnesis are more adapted and have less psycho-emotional stress than women who have a cesarean section for the first time. Key words: cesarean section, psychoemotional state, pregnancy, childbirth, scale J. Teylor, scale Ch. Spielberger, SAN-test.
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19

Mohammed, N., R. Tandon, and J. Pickett. "Obstetric crisis resource management: teaching and training multidisciplinary team using a high fidelity medical simulator for the delivery unit." Archives of Disease in Childhood - Fetal and Neonatal Edition 97, Suppl 1 (April 2012): A82.2—A82. http://dx.doi.org/10.1136/fetalneonatal-2012-301809.267.

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20

Di Renzo, Gian Carlo, Alexander D. Makatsariya, Valentina I. Tsibizova, Federica Capanna, Bartha Rasero, Eduard V. Komlichenko, Tatiana M. Pervunina, Jamilya Kh Khizroeva, Victoria O. Bitsadze, and Andrei S. Shkoda. "Obstetric and perinatal care units functioning during the COVID-19 pandemic." Annals of the Russian academy of medical sciences 75, no. 1 (March 30, 2020): 83–92. http://dx.doi.org/10.15690/vramn1324.

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The rapid spread of COVID-19 and the large number of cases put a significant burden on the health systems of any developed country. Specialists in natural disasters and military medicine should be involved in the provision of medical care and observance of anti-epidemic measures. In some countries, including Italy, they were involved only after the situation was dramatically worsening with many clinical units and hospitals overloaded by infected patients. To curb the spread of COVID-19, most countries declared a state of emergency, and unprecedented measures have been taken to strengthen quarantine in suspected or positive symptomatic subjects. Nevertheless, the crisis associated with the unexpectedly global scale and tragedy of the pandemic and the inconsistency of actions of both society and individuals and specialized medical services, lead to insufficient effectiveness of the measures taken in a number of regions. In the present day, it is vital for every person to change its mindset ― relying on personal responsibility to comply with all recommendations of quarantine and anti-epidemic measures, and to reorganize departments and resources of medical institutions at all levels in order to withstand the spread of infection and at the same time provide all those in need with the necessary and appropriate medical care. Particular attention should be paid to the obstetric care service, given that even in normal times, the obstetric hospital is an area of increased responsibility for the life and health of mother and child and future mankind. Fulfillment of existing orders, instructions of national and regional committees, international and national protocols and clinical protocols should undoubtedly lead to a positive result, but this requires additional training of medical personnel at all levels. The purpose of this review is to propose quick key strategies for reassessing the maternity and neonatal wards/ hospitals based on the experience of health systems and organizations which faced the spread of this new coronavirus; this advice may be applied along with binding tight instructions in obstetric hospitals in order to proactively respond to a likely wave of growth in COVID-19.
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Modi, Rahi S., Srushti S. Patel, Dipti A. Modi, and Heena Talesara. "Fetomaternal outcome in sickle cell disease in a tertiary care centre." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 2 (January 28, 2021): 619. http://dx.doi.org/10.18203/2320-1770.ijrcog20210315.

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Background: Sickle cell disease is a hereditary haematological disorder prevalent in tribal regions of India. Sickle cell disease can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the tertiary centre S.S.G. Hospital, Baroda, Gujarat. Hence this study was conducted to assess complications in pregnancy and maternal and perinatal outcome among women with Sickle cell disease.Methods: It was a retrospective observational study including all pregnant women with sickle cell disease after 20 weeks of gestation who delivered at S.S.G. Hospital, Baroda from August 2019 to August 2020.Results: There were 43 antenatal women with Sickle cell disease during the study period. There was increased risk of obstetric complications like gestational hypertension (11.62%), preeclampsia (9.3%), eclampsia (6.97%), HELLP syndrome (4.65%), intrauterine growth retardation (23.25%), and oligohydramnios (11.62%). Medical complications observed were mainly anaemia (53.48%), vaso-occlusive crisis (18.16%), acute chest syndrome (4.65%) and infections like urinary tract infection (6.97%) and pneumonia (4.65%). The incidence of low birth weight babies (56.94%), low APGAR score (11.62%) and neonatal ICU admissions (23.25%) was high. 6.5% cases of maternal mortality and 4.65% cases of perinatal mortality was observed.Conclusions: Pregnancy in Sickle cell disease is associated with an increased maternal morbidity and high perinatal mortality due to obstetric and medical complications.
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Mitrovic, Mirjana, Ivo Elezovic, Predrag Miljic, and Darko Antic. "Obstetric and gynecological intervention in women with Bernard-Soulier syndrome: Report of two cases." Srpski arhiv za celokupno lekarstvo 142, no. 5-6 (2014): 351–55. http://dx.doi.org/10.2298/sarh1406351m.

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Introduction. Bernard-Soulier syndrome (BSS) is a rare inherited bleeding disorder characterized by giant platelets thrombocytopenia e prolonged bleeding timee frequent hemorrhages with considerable morbidity. Data on the outcome of pregnancy and gynecological intervention in BSS are rare and there are no general therapeutic recommendations. Cases Outline. We report two cases of BSS. In the first case a 29-year-old patient with BSS was admitted in 8 weeks of gestation. The diagnosis of BSS was made on the basis of prolonged bleeding time, giant-platelets thrombocytopenia, and absent ristocetin-induced platelet aggregation. In 38 week of gestation Cesarean section, with platelets transfusion preparation, was performed. Obstetric intervention passed without complication. Postoperative course was complicated with a three-week vaginal bleeding resistant to platelet transfusion. Neonate platelet count was normal. Our second case was a 28-year-old patient with BSS, hospitalized for ovarial tumor surgery. The patient was prepared for the intervention with platelets transfusion. The surgery was uncomplicated, but on the second postoperative day a massive vaginal bleeding, resistant to the platelet transfusion, developed. Bleeding control was achieved with activated recombinant factor VII. Twelve hours the patient developed later hypertensive crisis with epileptic seizure due to subarachnoid hemorrhage. Therapy was continued with platelet transfusion, antihypertensive and antiedema drugs. PH examination of tumor tissue showed hemorrhagic ovarial cyst. Conclusion. Obstretic and gynecological intervention in women with BSS may be associated with a life-threatening bleeding thus requiring a multidisciplinary approach with adequate preparation. Because of the limited data in the literature, it is not possible to provide firm management recommendations and each case should be managed individually.
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Al Serouri, Abdul Wahed, Abdulla Al Rukeimi, Mohammed Bin Afif, Abdulrahman Al Zoberi, Jamela Al Raeby, Catherine Briggs, and Hamouda Hanafi. "Findings from a needs assessment of public sector emergency obstetric and neonatal care in four governorates in Yemen: a human resources crisis." Reproductive Health Matters 20, no. 40 (March 2012): 122–28. http://dx.doi.org/10.1016/s0968-8080(12)40665-6.

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24

Dusitkasem, Sasima, Blair H. Herndon, Dalton Paluzzi, Joseph Kuhn, Robert H. Small, and John C. Coffman. "From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia." Case Reports in Anesthesiology 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/5495808.

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Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features. Her initial presentation in hypertensive crisis with other symptoms led to diagnostic workup for secondary causes of hypertension and led to eventual diagnosis of paraganglioma. Obtaining this diagnosis prior to delivery was essential, as this led to prompt multidisciplinary care, changed the course of her clinical management, and ultimately enabled good maternal and fetal outcomes. This case highlights the importance of maintaining a high index of suspicion for secondary causes of hypertension and in obstetric patients and providing timely multidisciplinary care.
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Rebahi, Houssam, Mourad Ait Sliman, and Ahmed-Rhassane El Adib. "Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View." Case Reports in Obstetrics and Gynecology 2018 (September 18, 2018): 1–3. http://dx.doi.org/10.1155/2018/3138718.

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Background. Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes.Case Report. A 37-year-old pregnant woman, gravida 2, para 2, with a previous cesarean section in 2011, presented to the obstetric unit. Her medical past revealed that she is a newly diagnosed patient with CML managed by TKI during her preconception period. Due to the perilous use of TKI during her pregnancy, a switch to interferon-αadministration was adopted. But after the completion of 36 weeks of gestation, disease progression (relapse with blast crisis), attested by biological worsening, a white blood cell count = 245000/mm3with 32% blasts in the peripheral blood, urged the medical team to opt for cesarean delivery. She underwent general endotracheal anesthesia without any perioperative incidents and gave birth to a healthy newborn. Ten days later, the patient was started on TKI.Discussion. Although data on this specific and challenging situation are limited, this case highlights the difficulties encountered by the anesthesiologists when choosing the accurate anesthetic strategy and how important it is to weigh the risks and benefits inherent to each technique. Above all, taking into consideration the possible central nervous system (CNS) contamination by circulating blast cells when performing spinal or epidural approach is primordial. This potential adverse event (CNS blast crisis) is extremely scarce but it is responsible for high rates of morbidity and mortality.
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van Manen, Eline L. M., Martine Hollander, Esther Feijen-de Jong, Ank de Jonge, Corine Verhoeven, and Janneke Gitsels. "Experiences of Dutch maternity care professionals during the first wave of COVID-19 in a community based maternity care system." PLOS ONE 16, no. 6 (June 17, 2021): e0252735. http://dx.doi.org/10.1371/journal.pone.0252735.

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Background and objective During the COVID-19 pandemic the organization of maternity care changed drastically; this study into the experiences of maternity care professionals with these changes provides suggestions for the organization of care during and after pandemics. Design An online survey among Dutch midwives, obstetricians and obstetric residents. Multinomial logistic regression analyses were used to investigate associations between the respondents’ characteristics and answers. Results Reported advantages of the changes were fewer prenatal and postpartum consultations (50.1%). The necessity and safety of medical interventions and ultrasounds were considered more critically (75.9%); 14.8% of community midwives stated they referred fewer women to the hospital for decreased fetal movements, whereas 64.2% of the respondents working in hospital-based care experienced fewer consultations for this indication. Respondents felt that women had more confidence in giving birth at home (57.5%). Homebirths seemed to have increased according to 38.5% of the community midwives and 65.3% of the respondents working in hospital-based care. Respondents appreciated the shift to more digital consultations rather than face-to-face consultations. Mentioned disadvantages were that women had appointments alone, (71.1%) and that the community midwife was not allowed to join a woman to obstetric-led care during labour and subsequently stay with her (56.8%). Fewer postpartum visits by family and friends led to more tranquility (59.8%). Overall, however, 48.0% of the respondents felt that the safety of maternity care was compromised due to policy changes. Conclusions Maternity care professionals were positive about the decrease in routine care and the increased confidence of women in home birth, but also felt that safety in maternity care was sometimes compromised. According to the respondents in a future crisis situation it should be possible for community midwives to continue to deliver a personal handover after the referral of women to the hospital, and to stay with them.
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Jasovic-Gasic, M., A. Damjanovic, M. Ivkovic, and B. Dunjic-Kostic. "Postpartal psychosis: Serbian experience." European Psychiatry 26, S2 (March 2011): 1098. http://dx.doi.org/10.1016/s0924-9338(11)72803-6.

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IntroductionChildbirth and the postpartal period present a form of specific maturational crisis and an extremely vulnerable period for every woman, especially for those who have potential for some psychological disturbances.AimWe explored sociodemographic and clinical manifestations of women in the postpartal period who were hospitalized at the Institute of Psychiatry, Clinical Center of Serbia.MethodThis retrospective study included 60 patients with psychiatric disorders developed within six months after childbirth. Inclusion criteria were: negative psychiatric hystory, negative history of puerperal episode, and postpartal disorder as a first manifestation of psychiatric disturbances. Patients were diagnosed according to RDC criteria (research diagnostic criteria).ResultsPatients with psychotic features were predominant, average age 23.6; married; mothers of male offspring and with positive family history of psychiatric disorders in 30%. Subacute development of clinical manifestations was noticed, 3.5 weeks after childbirth on average. No psychopathology was observed before third postpartal day. Obstetric manifestations did not influence psychopathology.ConclusionChildbirth is a significant risk factor for the expression of mental dysfunction in the puerperal period. The most vulnerable group is women with clinical expression of dysfunction, specific sociodemographic characteristics, and positive family history of psychiatric disorders.
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Nisselle, Paul, and James F. Murray. "Obstetrics in crisis?" Medical Journal of Australia 159, no. 4 (August 1993): 219–21. http://dx.doi.org/10.5694/j.1326-5377.1993.tb137815.x.

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Mathew, John. "Obstetrics in crisis?" Medical Journal of Australia 159, no. 9 (November 1993): 633. http://dx.doi.org/10.5694/j.1326-5377.1993.tb138062.x.

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Rochelson, Burton, Michael Nimaroff, Adriann Combs, Benjamin Schwartz, Natalie Meirowitz, Nidhi Vohra, Victor R. Klein, et al. "The care of pregnant women during the COVID-19 pandemic – response of a large health system in metropolitan New York." Journal of Perinatal Medicine 48, no. 5 (June 25, 2020): 453–61. http://dx.doi.org/10.1515/jpm-2020-0175.

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AbstractThe rapid progression of the coronavirus disease 2019 (COVID-19) outbreak presented extraordinary challenges to the US health care system, particularly straining resources in hard hit areas such as the New York metropolitan region. As a result, major changes in the delivery of obstetrical care were urgently needed, while maintaining patient safety on our maternity units. As the largest health system in the region, with 10 hospitals providing obstetrical services, and delivering over 30,000 babies annually, we needed to respond to this crisis in an organized, deliberate fashion. Our hospital footprint for Obstetrics was dramatically reduced to make room for the rapidly increasing numbers of COVID-19 patients, and established guidelines were quickly modified to reduce potential staff and patient exposures. New communication strategies were developed to facilitate maternity care across our hospitals, with significantly limited resources in personnel, equipment, and space. The lessons learned from these unexpected challenges offered an opportunity to reassess the delivery of obstetrical care without compromising quality and safety. These lessons may well prove valuable after the peak of the crisis has passed.
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Anand, Gurpreet, and Felix Beuschlein. "MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency." European Journal of Endocrinology 178, no. 2 (February 2018): R45—R53. http://dx.doi.org/10.1530/eje-17-0975.

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With the introduction of hormonal substitution therapy in the 1950s, adrenal insufficiency (AI) has been turned into a manageable disease in pregnant women. In fact, in the light of glucocorticoid replacement therapy and improved obstetric care, it is realistic to expect good maternal and fetal outcomes in patients with AI. However, there are still a number of challenges such as establishing the diagnosis of AI in pregnant women and optimizing the treatment of AI and related comorbidities prior to as well as during pregnancy. Clinical and biochemical diagnoses of a new-onset AI may be challenging because of overlapping symptoms of normal pregnancy as well as pregnancy-induced changes in cortisol values. Physiological changes occurring during pregnancy should be taken into account while adjusting the substitution therapy. The high proportion of reported adrenal crisis in pregnant women with AI highlights persistent problems in this particular clinical situation. Due to the rarity of the disease, there is no prospective data-guiding management of pregnancy in patients with known AI. The aim of this review is to summarize the maternal and fetal outcomes based on recently published case reports in patients with AI and to suggest a practical approach to diagnose and manage AI in pregnancy.
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Blackledge, David, and Michael Prendergast. "Litigation: obstetrics in crisis?" Medical Journal of Australia 154, no. 10 (May 1991): 709. http://dx.doi.org/10.5694/j.1326-5377.1991.tb121286.x.

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Smith, Caroline, and Hannah Dahlen. "Caring for the Pregnant Woman and Her Baby in a Changing Maternity Service Environment: The Role of Acupuncture." Acupuncture in Medicine 27, no. 3 (September 2009): 123–25. http://dx.doi.org/10.1136/aim.2009.001115.

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Women have traditionally been high users of complementary therapies and use of these therapies continues during pregnancy and birthing. While women look to acupuncture and other therapies to support them during this time, traditional maternity services are in a state of change. In Australia, there is an increase in births, a workforce crisis, an increase in birthing in labour ward settings, few opportunities for women to birth at home, increased caesarean sections and an increase in obstetric interventions. The future role of acupuncture in this changed environment will be influenced by the evidence of safety and effectiveness of acupuncture. Research evaluating acupuncture during the antenatal period, labour preparation and birthing is small in quantity, but there are encouraging findings suggesting acupuncture maybe safe and effective. Women have prioritised interventions to manage pregnancy symptoms such as nausea and back pain, and interventions to prepare for labour and manage pain in labour as important. Further acupuncture trials are needed to ensure women have reliable and valid information to inform their decision making. Assessment of safety requires contributions from researchers, practitioners and integration with institutional data collection systems. Research of effectiveness should involve rigorous designs, but with debate about the appropriateness of traditional randomised controlled trial designs to evaluate complex interventions, and the limitations of sham controls, different approaches with mixed research methods should be considered. Exploring new research methods, especially those which explore the woman's experience with acupuncture, are also key to defining a role in the future.
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Pandya, Manish R., Meenakshi Patel, Janaki Bhesaniya, Shyam Patel, Sneha Patel, Khushbu Patel, and Amit Dave. "Pregnancy & Covid 19 infection: Our experience." Indian Journal of Obstetrics and Gynecology Research 8, no. 1 (March 15, 2021): 15–19. http://dx.doi.org/10.18231/j.ijogr.2021.003.

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Corona virus disease also known as Covid -19 pandemic has represented major impact to health system and societies world-wide. There is no particular high risk seen among mother and fetus. In addition to these aspects specifically to Covid -19 and gestation that should be known by specialist in order to correctly diagnose disease, classify severity, distinguish obstetric complications with specific signs of Covid -19 and for taking most appropriate management decision. The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has exposed vulnerable populations to global health crisis. Mother and fetuses are particularly susceptible to poor outcome. There are very limited data how SARS‐CoV‐2 behaves in pregnant women & their infants. We pearly reviewed 52 gravida infected with covid-19 pneumonia. Out of which 25 symptomatic patients admitted to our hospital while 27 asymptomatic but Covid positive patients care taken on OPD basis followed by home quarantine for 14 days. 1) To summarize the clinical features of Covid-19 in pregnancy; 2) Any intervention helps for better maternal and perinatal outcome. 3) Safety profile of Remdesivir in third trimester of pregnancy with Covid-19 pneumonia. This was a single-centre; meta-analysis performed at Sunshine global hospital Vadodara Gujarat designated hospitals for pregnancy with COVID-19 in the epicentre of the SARS-CoV-2 outbreak and medical consultation/collaboration with Scientific Research Institute, Surendranagar, Gujarat. We included pregnant women with COVID-19 from inpatient & outpatient department.
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Low, James A. "The Current Crisis in Obstetrics." Journal of Obstetrics and Gynaecology Canada 27, no. 11 (November 2005): 1031–37. http://dx.doi.org/10.1016/s1701-2163(16)30503-5.

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Mehendale, Madhuri Alap, Bhavya Doshi, Arun H. Nayak, Archana A. Bhosale, and Snehal Mulik. "Pregnancy in a Sickle Cell Disease Patient: A Nightmare!" Journal of South Asian Federation of Obstetrics and Gynaecology 12, no. 5 (2020): 323–25. http://dx.doi.org/10.5005/jp-journals-10006-1821.

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ABSTRACT Aim To discuss the effect of pregnancy in sickle cell disease (SCD) patients and its associated complications. Background Sickle cell disease is the most common inherited disorder worldwide and in certain regions of India with varying clinical severity and potentially serious complications. Sickle cell disease can magnify complications during pregnancy and in turn negatively influence the pregnancy outcomes. The physiological adaptations during pregnancy that occur in the circulatory, hematologic, renal, and pulmonary systems can overburden organs that already have chronic injuries secondary to SCD, thus increasing the rate of obstetric complications like miscarriage, anemia, preeclampsia, worsening of vaso-occlusive crisis, and acute chest syndromes. Case description A 23-year-old Indian primigravida patient, known case of SCD with anemia and splenic infarct with h/o multiple blood transfusions. The patient presented at 12 weeks with intrauterine fetal demise and was medically aborted. The post-abortion patient was posted for splenectomy as she had episodes of hemolytic jaundice. Post-splenectomy patient further developed bowel obstruction and thrombus formation in the infrarenal part of inferior vena cava (IVC). She was again operated and for obstruction and the band was removed. For thrombi, patient was given low molecular weight heparin (LMWH). The patient was finally discharged on tb. hydroxyurea and other antibiotics. Conclusion The higher rate of complications occurs in women with sickle cell crisis exaggerated by underlying factors such as long-term anemia and pregnancy increases the risk further. Thus, a multidisciplinary approach with regular follow-up of SCD patients since the time of preconceptional time is important to avoid pregnancy-related complications and also for a better pregnancy outcome. Clinical significance The physiological changes of pregnancy like increased blood volume, increased metabolic demand, increased blood viscosity, and hypercoagulability get aggravated in SCD patients leading to increased incidence of complications. Prepregnancy anemia and other complications of a mother can further affect the outcome, thus preconceptional counseling is a crucial part of management. How to cite this article Doshi B, Mehendale MA, Nayak AH, et al. Pregnancy in a Sickle Cell Disease Patient: A Nightmare!. J South Asian Feder Obst Gynae 2020;12(5):323–325.
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Iglesias, S. "Rural Obstetrics—Responding to the Crisis." Journal SOGC 21, no. 13 (November 1999): 1206–7. http://dx.doi.org/10.1016/s0849-5831(16)30468-2.

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38

Nhan, Carol, Meredith Young, Ilana Bank, Peter Nugus, Rachel Fisher, Milène Azzam, and Lily H. P. Nguyen. "Interdisciplinary Crisis Resource Management Training: How Do Otolaryngology Residents Compare? A Survey Study." OTO Open 2, no. 2 (April 2018): 2473974X1877040. http://dx.doi.org/10.1177/2473974x18770409.

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Objective Emergent medical crises, such as acute airway obstruction, are often managed by interdisciplinary teams. However, resident training in crisis resource management traditionally occurs in silos. Our objective was to compare the current state of interdisciplinary crisis resource management (IDCRM) training of otolaryngology residents with other disciplines. Methods A survey study examining (1) the frequency with which residents are involved in interdisciplinary crises, (2) the current state of interdisciplinary training, and (3) the desired training was conducted targeting Canadian residents in the following disciplines: otolaryngology, anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, internal medicine, pediatric emergency medicine, and pediatric/neonatal intensive care. Results A total of 474 surveys were completed (response rate, 12%). On average, residents were involved in 13 interdisciplinary crises per year. Only 8% of otolaryngology residents had access to IDCRM training, as opposed to 66% of anesthesiology residents. Otolaryngology residents reported receiving an average of 0.3 hours per year of interdisciplinary training, as compared with 5.4 hours per year for pediatric emergency medicine residents. Ninety-six percent of residents desired more IDCRM training, with 95% reporting a preference for simulation-based training. Discussion Residents reported participating in crises managed by interdisciplinary teams. There is strong interest in IDCRM and crisis resource management training; however, it is not uniformly available across Canadian residency programs. Despite their pivotal role in managing critical emergencies such as acute airway obstruction, otolaryngology residents received the least training. Implication IDCRM should be explicitly taught since it reflects reality and may positively affect patient outcomes.
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Acharya, Ganesh, and Magnus Westgren. "Obstetrics and gynecology - a specialty in crisis?" Acta Obstetricia et Gynecologica Scandinavica 95, no. 10 (September 19, 2016): 1087–88. http://dx.doi.org/10.1111/aogs.12946.

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Gosman, G. G., M. R. Baldisseri, K. L. Stein, T. A. Nelson, S. H. Pedaline, J. H. Waters, and H. N. Simhan. "Introduction of an Obstetric-specific Medical Emergency Team for Obstetric Crises: Implementation and Experience." Obstetric Anesthesia Digest 28, no. 4 (December 2008): 227–28. http://dx.doi.org/10.1097/01.aoa.0000337927.24244.4f.

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Gosman, Gabriella G., Marie R. Baldisseri, Karen L. Stein, Trish A. Nelson, Susan H. Pedaline, Jonathan H. Waters, and Hyagriv N. Simhan. "Introduction of an obstetric-specific medical emergency team for obstetric crises: implementation and experience." American Journal of Obstetrics and Gynecology 198, no. 4 (April 2008): 367.e1–367.e7. http://dx.doi.org/10.1016/j.ajog.2007.06.072.

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Raider, Faith S., Susan Paulukonis, Ward Hagar, Marsha J. Treadwell, and Mary Hulihan. "Mortality Among Women with Sickle Cell Disease Admitted for Delivery, California 2004-2014." Blood 128, no. 22 (December 2, 2016): 2332. http://dx.doi.org/10.1182/blood.v128.22.2332.2332.

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Abstract Maternal mortality results among women with sickle cell disease (SCD) from recent population-based studies using US hospital discharge data range from 72 (Villers, 2008) to 160 per 100,000 (Alayed, 2014). Researchers use hospital discharge or death certificate data to examine maternal death, as no national SCD surveillance system exists. We analyze California's surveillance data to describe the in-hospital maternal mortality rate among women meeting a stringent case definition for SCD, compare that rate to rates for all women and for Black women, and describe cases of SCD maternal demise. The CDC has developed the Sickle Cell Data Collection (SCDC) program to conduct state level surveillance in this disease. SCDC uses a validated case definition: confirmed SCD with known genotype (via newborn screening or clinical case reports) or three or more healthcare encounters in administrative or claims data with SCD ICD-9 codes. California SCDC collected hospitalization data for years 2004-2014 on 1,829 women with SCD. We queried hospitalization data for women ages 15-45 at time of admission for ICD-9 codes for delivery (V27.X) with disposition codes indicating death during the same admission. We used the same query for all women and for Black women to calculate comparable in-hospital maternal mortality rates. We reviewed death records for ICD-10-CM underlying cause of death (COD) codes, and prior ED and inpatient records, and describe the history of the women with SCD who died. We found 636 delivery hospitalizations among 441 of the 1,829 eligible women with SCD during the 11-year period. The maternal death rate for SCD was 629 per 100,000 (n = 4 of 636 deliveries), compared to 6 per 100,000 deliveries in the general population and 12 per 100,000 among Black women. There was an additional death (#5) among the women with SCD that occurred shortly after discharge; we include this death in the case descriptions, but not in the mortality rates. All of the women with SCD who died were Black. All births were live, singleton deliveries by cesarean surgery. Case #1: 29 years old at death with no prior pregnancies in nine years of utilization data. She had a history of eight hospitalizations for septicemia, pneumonia and Hb SS with crisis, but none during her pregnancy. There were 16 ED visits, most related to SCD crisis and pain, but none in the prior three years. COD was 'O96.0, Death from direct obstetric cause.' Case #2 was 34 years old and had seven prior years of medical history. She had no record of previous pregnancies, but had 44 prior hospital admissions and 95 ED encounters, including 12 in the year prior to her death. She had a history of venous thromboembolism, and deep phlebothrombosis was the primary diagnostic code for her final hospital admission. COD was 'D57.1 Sickle cell disease without crisis.' Case #3 was 28, with four years of prior data. There was one previous cesarean birth 2.5 years prior to her death, and a record indicating that there were one or more prior cesarean deliveries before that. She had 11 prior ED encounters, most for pain, with one in the year prior to her death; there were 46 prior hospitalizations, most for SCD crisis. Primary diagnosis was severe pre-eclampsia. COD was 'D57.1 Sickle cell disease without crisis.' Case #4 was 27, and had eight years of prior data and no prior births. She had 11 admissions, three in the months prior to her death for antepartum anemia. There were 12 prior ED encounters, three for antepartum anemia. Her death included codes for heart, liver, kidney and respiratory failure after delivery. COD was 'O96.0,' as described in Case #1. She died 11 days after delivery. Case #5 was 20, and had five years of utilization data with no prior births. Her labor was induced due to fetal distress, and she was hospitalized for six days. Records included a code for infection of the amniotic cavity. Four days after release, she was re-admitted for puerperal sepsis, suffered multi-organ failure, and died. There were 10 prior ED encounters, including four during and related to the pregnancy. COD was 'O23.5, Infections of the genital tract in pregnancy.' We found maternal mortality among women with SCD to be significantly higher than previous estimates. Statewide surveillance based on multiple data sources, and that follows individual patients over time whether or not they are seen in sickle cell disease clinics, can provide less biased information on health outcomes than analyses of single data sources or clinical sites. Disclosures Raider: Pfizer: Research Funding; Biogen: Research Funding. Paulukonis:Pfizer: Research Funding; Biogen: Research Funding.
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De Obstetricia y Ginecologia, Federación Colombiana. "El aborto una crisis en progreso." Revista Colombiana de Obstetricia y Ginecología 41, no. 3 (September 28, 1990): 201–2. http://dx.doi.org/10.18597/rcog.968.

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El tema del aborto produce preguntas profundas y dolorosas que la mayor parte de las personas prefieren ignorarlas o hacerse indiferentes. Pero los Gineco-Obstetras no pueden dejar pasar el problema ya que sus consecuencias pueden ser funestas.
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Rowe, Timothy. "Crisis? What Crisis?" Journal of Obstetrics and Gynaecology Canada 30, no. 7 (July 2008): 557–58. http://dx.doi.org/10.1016/s1701-2163(16)32881-x.

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Chervenak, Frank A., and Laurence B. McCullough. "Responding Professionally to the Liability Crisis in Obstetrics and Gynecology." Clinics in Perinatology 34, no. 3 (September 2007): 503–8. http://dx.doi.org/10.1016/j.clp.2007.04.003.

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Huamán G., Moisés, Manuel Huamán G., and José Pacheco Romero. "NUTRICIÓN PARENTERAL TOTAL EN OBSTETRICIA." Revista Peruana de Ginecología y Obstetricia 31, no. 3 (May 17, 2015): 65–67. http://dx.doi.org/10.31403/rpgo.v31i620.

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Se presenta dos casos de gestantes tratadas con Nutrición Parenteral Total (NPT) por crisis addisoniana e hiperemessis gravídica, respectivamente, haciéndose una breve revisión de este interesante tema, así como las indicaciones de la NPT en obstetricia. Nuestro reporte es el primero en el Perú.
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Caldwell, John C. "Africa Faces Reproductive Crisis / L'Afrique face à des crises de santé reproductive." African Journal of Reproductive Health 1, no. 2 (September 1997): 10. http://dx.doi.org/10.2307/3583372.

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48

Alamer, Zaina Abdelhalim, Mohammed Alkhatib, Emad Naem, Noor Nabeel M. Suleiman, Marwa Gomaa Mokhtar, and Dabia Hamad Al-Mohanadi. "Challenging Thyroid Storm in Pregnancy, Case Report." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A923—A924. http://dx.doi.org/10.1210/jendso/bvab048.1887.

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Abstract Background: Thyroid storm is a rare complication of hyperthyroidism. It can lead to life-threatening complications such as Arrhythmias, multiorgan failure and disseminated intravascular coagulation (DIC) (1). In pregnant patients can cause spontaneous abortions, fetal demise (2). Aggressive treatment under critical care settings is needed. Clinical Case: We report a case of 24-year-old Indian female twelve weeks pregnant; background of Graves’ disease for five years, was on carbimazole but she discontinued since she became pregnant. Presented to Hamad general hospital with nausea, vomiting and altered mental status for one day. She was afebrile, normotensive, tachypneic, tachycardiac with heart rate of 150bpm, and confused. Investigations showed supraventricular tachycardia aborted by adenosine and amiodarone, TSH was &lt; 0.01mIU/l(0.3-4.2) and FT4&gt; 100 pmol/L(11.6-21.9),normal baseline liver function and complete blood counts. In the emergency department, she was managed for thyroid storm with hydrocortisone, propranolol, propylthiouracil (PTU), iodine solution and cholestyramine. Then suddenly she deteriorated requiring intubation and vasopressor support under care of Medical Intensive Care Unit (MICU) progressed to multiorgan failure; acute liver injury, acute kidney injury and DIC. So, PTU was stopped and started on plasma exchange followed by total thyroidectomy and tracheostomy. US pelvis showed nonviable fetus, so dilation and curettage were done by obstetric team. Afterwards, she markedly improved except her conscious level and kidney function which required Hemodialysis. MRI brain showed small subdural hematoma treated conservatively and Wernicke encephalopathy treated with thiamine with substantial response and spontaneously breathing. Post thyroidectomy she required calcium supplementation and levothyroxine, liver function and coagulation parameters back to baseline. Conclusion: Thyroid storm in pregnancy is a medical emergency with high mortality rate, it needs high index of suspicion and early aggressive management by a multidisciplinary team. Plasmapheresis may be considered for challenging cases as a bridge for definitive therapy. Thyroidectomy may be the only option in selected cases like our case. References: 1. Karger S, Führer D. Thyreotoxische Krise--ein Update [Thyroid storm--thyrotoxic crisis: an update]. Dtsch Med Wochenschr. 2008 Mar;133(10):479-84. German. doi: 10.1055/s-2008-1046737. PMID: 18302101. 2. Ma Y, Li H, Liu J, Lin X, Liu H. Impending thyroid storm in a pregnant woman with undiagnosed hyperthyroidism: A case report and literature review. Medicine (Baltimore). 2018;97(3):e9606. doi:10.1097/MD.0000000000009606
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Berkenstadt, Haim, Erez Ben-Menachem, Rina Dach, Tiberiu Ezri, Amitai Ziv, Orit Rubin, and Ilan Keidan. "Deficits in the Provision of Cardiopulmonary Resuscitation During Simulated Obstetric Crises." Survey of Anesthesiology 57, no. 4 (August 2013): 185–86. http://dx.doi.org/10.1097/01.sa.0000431211.73718.c6.

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Chestnut, D. H. "Deficits in the provision of cardiopulmonary resuscitation during simulated obstetric crises." Yearbook of Anesthesiology and Pain Management 2011 (January 2011): 294–95. http://dx.doi.org/10.1016/j.yane.2010.11.003.

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