Abstract

Medical emergencies in pregnant women pose many challenges if both the baby and mother are to have an optimal outcome. Multidisciplinary team working is essential to ensure that the correct treatment is offered, and that potentially lifesaving options are not discarded because of unwarranted concerns about safety in pregnancy. Expertise should be sought from doctors with a special interest in obstetric medicine.

Clinical problems include those unique to pregnancy such as eclampsia or acute fatty liver of pregnancy, exacerbations of chronic medical diseases some of which can be predicted such as pulmonary hypertension, or conditions which have an increased frequency in pregnancy including thromboembolism, urinary tract infection and Bell’s palsy. Cardiopulmonary resuscitation in pregnancy should be managed in the left lateral position, with early recourse to delivery of the fetus.
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References

1. Casson IF, Clarke CA, Howard CV, et al; Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. BMJ, 1997; 315: 275-278.
2. Cydulka RK, Emerman CL, Schreiber D, et al; Acute asthma among pregnant women presenting to the emergency department. Am J Resp Crit Care Med 1999; 160: 887-92.
3. Girling JC. Re-evaluation of creatinine in pregnancy. Journal Obstetrics and Gynaecology 2000; 20: 128-131.
4. Girling JC, Dow E, Smith JH. Liver function tests in pre-eclampsia: the importance of comparison with a reference range derived for normal pregnancy’. British Journal Obstetrics and Gynaecology 1997; 104: 246-50.
5. Lind T, Godfrey KA, Otun H, et al; Changes in serum uric acid concentrations during normal pregnancy. Br J Obs Gynae 1984; 91: 128-132.
6. Van den Broek NR, Letsky E. Pregnancy and the erythrocyte sedimentation rate. Br J Obstet Gynaecol 2001; 108: 1164-67.
7. Stirling Y, Woolf L, North WRS, et al; Haemostasis in normal pregnancy. Thrombosis Haemostasis 1984; 52: 176-182.
8. Darmady JM, Postle AD. Lipid metabolism in pregnancy. Br J Obstet Gynae 1982; 89: 211-215.
9. Why mothers die 1997-1999, the confidential enquiries into maternal deaths in the United Kingdom RCOG Press, London 2001.
10. Douglas KA, Redman CWG. Eclampsia in the United Kingdom. BMJ 1994; 309: 1395-1400.
11. Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence form the Collaborative Eclampsia Trial. Lancet 1995; 345: 1455-63.
12. Adab N, Jacoby A, Smith D, et al; Additional educational needs in children born to mothers with epilepsy. J Neurol Neurosurg Psychiatry 2001; 70: 15-21.
13. Thromboembolic disease in pregnancy and the puerperium: acute management. RCOG Guideline number 28, April 2001.
14. Casele HL, Laifer SA Woelkers DA, et al; Changes in pharmacokinetics of the low molecular weight heparin enoxaparin sodium during pregnancy. Am J Obstet Gynaecol 1999; 181: 1113-7.
15. Midei Mg, deMent SH, Feldman AM, et al; Peripartum myocarditis and cardiomyopathy. Circulation 1990; 81: 922-8.
16. Elkayan U, Tummala PP, Rao K, et al; Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. New Engl J Med 2001; 344: 1567-71.
17. Castro MA, Ouzounian JG, Colleti PM. Radiological studies in acute fatty liver of pregnancy. A review of the literature and 19 new cases. J Reprod Medicine. 1996; 41: 839-43.
18. Magann EF, Bass D, Chauhan SP, et al; Antepartum corticosteroids: disease stabilisation in patients with the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP). Am J Obstet Gynecol. 1994; 171: 1148-1153.
19. Magann EF, Perry KG, Meydrech EF, et al; Postpartum corticosteroids: accelerated recovery from the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP). Am J Obstet Gynecol 1994; 171: 1154-1158.
20. Kenyon, AP, Nelson-Piercy C, Girling JC, et al; Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG: an international journal of obstetrics and gynaecology. 2002; 109: 282-88.
21. Williamson C, Gorelik J, Eaton BM, et al; The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intrauterine fetal death in obstetric cholestasis. Clin Science 2001; 100: 363-369.