Critical Care Obstetrics part 26 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 | Pregnancy-Related Stroke Corticosteroids The potential place of corticosteroids for stroke prevention in the hypertensive pregnant patient particularly with severe preeclampsia or HELLP syndrome is a worthy consideration 61 . Intravenous high-dose dexamethasone has been shown to reduce significant maternal morbidity when given early or late during the course of disease development in patients with HELLP syndrome and it probably reduces the likelihood of patients with this disorder developing cerebral sequelae to their disease 61 . Cerebral hemodynamic studies in patients with HELLP syndrome reveal similar findings to patients with pre- eclampsia 109 . Almost all deaths due to stroke in patients with HELLP syndrome occur in the absence of aggressive pre- emptive corticosteroid therapy for basic disease management 58 61 . A cornerstone of management for patients with hypertensive encephalopathy is the administration of this category of drugs in association with antihypertensive and diuretic agents. Experience with a recent patient who had severe gestational hypertension that quickly and repeatedly returned after treatment with small frequent intravenous administrations of labetalol and who suffered a cerebral hemorrhage raises the question of whether obstetricians should be more aggressive with labetalol or other agents for blood pressure control or whether this approach alone is unlikely to succeed without another agent such as glucocorticoids to interrupt cerebral pathophysiology and thereby avert CVA. Because sudden hypertension can result from rather than lead to intracranial bleeding the initiation of potent glucocorticoids or other agents may augment poorly effective antihypertensive therapy and potentially avoid adverse cerebral sequelae. It is important to recognize that steroid therapy in potential stroke patients is not believed to act through any effect on cerebral edema prevention or alleviation as it does when used in the management of cerebral edema due
