Assessing the Critically-ill Pregnant Patient

  • Critical illness during pregnancy is rare, but it carries an increased morbidity and mortality when it occurs
  • Several cardiopulmonary changes normally occur during pregnancy and result in less reserve when critical illness occurs.
  • The mnemonic T.O.L.D. can help you remember the most important first interventions when evaluating these patients
    • Tilt patient 30-45 left lateral decubitus to decrease the compression of the IVC / aorta by the gravid uterus
    • Oxygen should be provided immediately as the pregnant patient can desaturate quickly
    • Lines (IV) should be placed early on and large bore when needed above the diaphragm (due to caval compression)
    • Dates / Delivery (call L&D) early. Knowing dates helps to understand fetal viability and calling L&D early to monitor fetal heart rate after 20-24 weeks of pregnancy¬†