Critical Care Obstetrics part 55 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 | Overdose Poisoning and Envenomation During Pregnancy vated creatinine elevated urinalysis. Plasma acetaminophen level obtained 4 or more hours after ingestion can be plotted on a Rumack-Matthew nomogram Figure . A level drawn less than 4 hours after ingestion may be falsely low resulting from a partial absorption. Electrocardiogram EKG nonspecific ST T changes. Short-term problems Oliguria pancreatitis hypotension myocardial ischemia and necrosis. Premature contractions potential for premature delivery. Long-term problems Diffuse hepatic necrosis potential for 1-2 late mortality Fetal and neonatal considerations General Acetaminophen crosses the placenta the fetus is at risk of poisoning particularly late in pregnancy 44 . Unless severe maternal toxicity develops acetaminophen overdose does not appear to increase the risk for adverse pregnancy outcome 45 . Placental transfer of therapeutic levels of N-acetylcysteine has been documented in humans and provides evidence of a direct antidotal effect of N-acetylcysteine in the fetus 46 . Signs Decreased fetal movements decreased beat to beat variability absence of fetal heart rate accelerations falling baseline heart rate see Figure . Figure Nomogram for acetaminophen toxicity. Modified from Rumack RH Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975 55 871 . Reproduced by permission of McNeil Pharmaceuticals. 529 Chapter 39 Teratogenic potential No support for association potential for fetal liver damage hepatocellular necrosis increased risks of spontaneous abortion and stillbirth. Case control studies have not found an evidence of increased malformations after prenatal acetaminophen 47 . A report on 300 overdoses during pregnancy did not suggest an increase in adverse pregnancy outcome attributable to the drug ingestion 48 . Fetal distress potential Yes reported 49 . There is a relationship between pregnancy outcome and the interval between drug exposure and administration of N- .
