Neurologic disorders in pregnancy.

Abstract:

BACKGROUND:Neurologic dysfunction, coma, and seizures are common in obstetric patients in the intensive care unit. OBJECTIVE:To review common neurologic disorders resulting in critical illness in pregnancy. REVIEW:Obstetric disorders causing coma and seizures include eclampsia, acute fatty liver of pregnancy, and amniotic fluid embolism. Preexisting disorders such as epilepsy may worsen in one-third of pregnant patients, and seizures are common during labor. Changes in hemodynamics, blood volume, and hormonal effects on the vessel wall increase risk of bleeding from berry aneurysms and arteriovenous malformations during pregnancy and the postpartum period. Acute intermittent porphyria produces seizures and hypertension, closely mimicking eclampsia. Cerebral venous sinus thrombosis is common in postpartum patients, especially in developing countries. Brain tumors invariably enlarge during pregnancy because of fluid retention and the presence of estrogen and progesterone receptors on tumor cells. Infections such as cerebral malaria and acute viral hepatitis with fulminant hepatic failure are common causes of coma and seizures during pregnancy in tropical regions of Asia, Africa, and Latin America. Patients may be admitted to the intensive care unit with type II respiratory failure due to myasthenic crisis, Guillain-Barre syndrome and spinal cord disease. Relapses of multiple sclerosis are infrequent during pregnancy but increase in the postpartum period. CONCLUSIONS:In all instances, the effects of the disorders, diagnostic tests, and treatment on the fetus must be carefully weighed. Prompt delivery may be lifesaving for mother and fetus in conditions such as eclampsia and acute fatty liver of pregnancy; expectant treatment may be more appropriate in others.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Karnad DR,Guntupalli KK

doi

10.1097/01.ccm.0000182790.35728.f7

subject

Has Abstract

pub_date

2005-10-01 00:00:00

pages

S362-71

issue

10 Suppl

eissn

0090-3493

issn

1530-0293

pii

00003246-200510001-00018

journal_volume

33

pub_type

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