Obstetric Critical Care

Program Overview

This curriculum aims to provide specialized training in the management of critically ill obstetric patients. It will cover essential skills, knowledge, and competencies necessary to provide high-quality care in an intensive care unit (ICU) for pregnant or postpartum women. Trainees will learn to identify, manage, and prevent complications unique to obstetric patients in critical settings.

Target Audience

• Anesthesiologists

• Critical Care Physicians

• Obstetricians

• Maternal-Fetal Medicine Specialists

• ICU Nurses

• Residents and Fellows in Critical Care Medicine or Obstetrics

Duration

• Core Online Program: 2 months (for basic exposure)

Learning Objectives

Upon completion, participants should be able to:

• Recognize and manage obstetric emergencies requiring critical care.

• Perform comprehensive assessments and provide multidisciplinary care for critically ill obstetric patients.

• Apply principles of maternal and fetal physiology in critical care decision-making.

• Manage invasive monitoring, mechanical ventilation, and pharmacotherapy specific to the obstetric population.

• Implement evidence-based guidelines in obstetric critical care.

Core Curriculum Components

1. Maternal Physiology and Pathophysiology

• Normal Maternal Physiology: Cardiovascular, respiratory, renal, and hematologic changes during pregnancy.

• Fetal-Maternal Interface: Placental physiology and fetal monitoring in critical settings.

• Pathophysiology of Common Obstetric Conditions:

• Hypertensive disorders (e.g., preeclampsia, eclampsia, HELLP syndrome)

• Hemorrhage (e.g., placental abruption, uterine atony)

• Sepsis and septic shock in pregnancy

• Respiratory distress and ARDS in pregnancy

• Amniotic fluid embolism

• Cardiac disease in pregnancy (e.g., peripartum cardiomyopathy)

2. Critical Care Fundamentals

• General Critical Care Concepts:

• Hemodynamic monitoring and support

• Invasive and non-invasive ventilation in pregnancy

• Renal replacement therapy and fluid management

• Blood transfusion and management of coagulopathy

• Antibiotic and antimicrobial use in pregnancy

• Management of multi-organ dysfunction syndrome (MODS)

• Advanced Airway Management in Obstetrics:

• Difficult airway in pregnancy

• Intubation techniques and strategies

• Emergency C-section in the ICU setting

3. Obstetric-Specific Critical Care

• Obstetric Emergencies:

• Management of massive obstetric hemorrhage (role of transfusion protocols, uterotonics)

• Management of preeclampsia/eclampsia and seizures

• Management of amniotic fluid embolism

• Peripartum cardiomyopathy and other cardiac conditions

• Management of thrombosis and thromboembolism in pregnancy (DVT, PE)

• High-risk maternal transport and inter-hospital transfer protocols

• Sepsis in Obstetrics:

• Pathophysiology and early recognition of sepsis in pregnancy

• Sepsis bundles and protocol-based management

• Monitoring and supportive care for septic shock

4. Anesthesia in Obstetric Critical Care

• Perioperative Management:

• Preoperative assessment of critically ill obstetric patients

• General and regional anesthesia considerations in obstetrics

• Postoperative care and monitoring of high-risk obstetric patients

• Analgesia and Sedation:

• Pain management in critically ill obstetric patients

• Sedation protocols and considerations during pregnancy

5. Interdisciplinary Collaboration

• Multidisciplinary Teamwork:

• Coordination with obstetricians, neonatologists, anesthetists, and critical care staff.

• Ethical decision-making in maternal and fetal care.

• End-of-life care in obstetrics: ethical considerations, cultural sensitivities.

Recommended Resources

• Textbooks:

• “Critical Care Obstetrics” by Michael A. Belfort and George R. Saade

• “Chestnut’s Obstetric Anesthesia: Principles and Practice” by David H. Chestnut

• Guidelines:

• Society of Critical Care Medicine (SCCM) guidelines

• Obstetric anesthesia guidelines (American Society of Anesthesiologists)

• Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for managing maternal critical illness