Critical Care Obstetrics part 60 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 | Septic Shock Although the increased susceptibility to endotoxin-mediated injury in pregnant animals is a consistent observation in the literature 104-106 different animal species appear to succumb to different physiologic aberrations. As such caution is warranted in applying the results of animal studies to critically ill pregnant women. It is interesting to note that in experimental animal models the fetus is more resistant to the deleterious effects of endotoxin than is the mother. Bech-Jansen et al. 105 demonstrated that although blood flow to the uterus declined out of proportion to maternal hypotension the fetal sheep was able to tolerate endotoxin doses tenfold higher than those proven to be lethal in adult pregnant sheep. Indeed the fetal circulation was not affected until the adult s condition was terminal. The investigators suggest that this protective effect is due to the immature status of the fetal vascular responsiveness. In contrast Morishima et al. 106 administered endotoxin to pregnant baboons and observed rapid and profound fetal asphyxia acidemia and death in concert with maternal circulatory collapse. The investigators concluded that the rapid deterioration in fetal wellbeing was due primarily to maternal factors such as hypotension and increased myometrial activity both of which contributed to a reduction in placental perfusion. Although the pathophysiologic basis for the increased susceptibility to endotoxin-mediated injury during gestation remains speculative published data suggest that a pregnant woman should be considered a compromised host. The response of the parturient to an infectious stimulus probably represents the combined effects of alterations in her physiology as well as enhanced responsiveness to the effects of endotoxin. Although the fetus is likely more resistant to the effects of endotoxin than the mother alterations in uteroplacental flow can lead to hypoxia acidosis placental abruption fetal cerebral injury including .
