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Critical Care Obstetrics part 41

Critical Care Obstetrics part 41 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Acute Fatty Liver of Pregnancy gastric tube. Nitrogenous waste production can be reduced further by exclusion of protein intake during the acute phase of the illness. Once clinical improvement is evident protein intake should gradually be restored. With rare exceptions any drug that requires hepatic metabolism should be withheld from the patient. Colonic emptying should be facilitated through the use of enemas and or magnesium citrate ammonia production by intestinal bacteria may be diminished by the administration of neomycin 6-12 g orally per day. Exchange transfusion hemodialysis plasmapheresis extracorporeal perfusion and corticosteroids have all been used to treat fulminant hepatic failure 39 and should be considered in cases unresponsive to traditional management. Successful liver transplantation has also been reported in women with AFLP who continue to deteriorate in spite of delivery and appropriate supportive care 40-42 . However because the pathophysiologic changes associated with AFLP are reversible transplantation is inappropriate in all but the most extreme cases 1 43 . Successful temporary auxiliary liver transplant has also been reported 41 . Mild coagulation abnormalities need not be corrected if delivery can be accomplished atraumatically and there is no evidence of clinical bleeding. However in the presence of hemorrhagic complications or if surgery is contemplated the coagulation abnormalities should be corrected with platelet fresh frozen plasma or cryoprecipitate transfusion based on the results of laboratory evaluation. The successful use of antithrombin 1 43 and factor VII 44 concentrations have also been reported. Morbidity from other potential complications may be prevented by prophylactic treatment and careful surveillance. The liberal use of broad-spectrum antibiotics may decrease the incidence of concomitant infection 1 . Prophylactic administration of antacid solutions and H2 blocking agents may decrease the risk of gastrointestinal .