General points for maternal critical care patients:

• Treat pregnant and postpartum women the same as non-pregnant women unless there is a clear reason not to
• Omitting treatments/intervention is generally more harmful than giving them in pregnant patients
  

Medications

• UK Tetralogy Information Service Best Use of Medicines in Pregnancy (UKTIS/BUMPS) website is a reliable and useful resource regarding drugs
• Dose as you would for non-pregnant patient
  

Patients with cardiovascular disease:

• DC cardioversion can be carried out at any gestation, if needed
  

NORMAL PHYSIOLOGICAL PARAMETERS

• Heart rate: increased by 10–20bpm, particularly in third trimester
• Blood pressure: can decrease by 10–15mmHg by 20 weeks, but returns to pre-pregnancy levels by term
• Respiratory rate: unaltered. If RR >20, consider pathological cause
• Oxygen saturation: unchanged throughout pregnancy
• Temperature: unchanged throughout pregnancy
  

SPECIFIC DRUGS FOR MATERNAL CRITICAL CARE

• Antiarrhythmics: avoid amiodarone, others are safe
• Antibiotics: avoid tetracyclines
• Anticonvulsants: avoid sodium valproate (see hypertensive disorders card)
• Opioids and antiemetics: can be given safely
• Steroids and nebulised bronchodilators: can be given safely
• Thrombolysis: pregnancy not an absolute contraindication. Give where benefits > risk
  

SPECIFIC ADVICE FOR MANAGING PREGNANT WOMEN

• Where possible, position patient in left lateral position if >24/40
• During transfer, consider [TBC – waiting for Intensive Care Society guideline]
  

NORMAL ECG VARIANTS IN PREGNANCY

• Transient ST segment and T wave changes
• Q wave and inverted T waves in lead III
• Attenuated Q wave in lead AVF
• Inverted T waves in leads V1, V2, and, occasionally, V3