Abstract

TRANSPORTATION IN OBSTETRIC CRITICALLY ILL PATIENTS

April Poerwanto Basoeki Department of Anesthesiology and Reanimation of Dr. Soetomo Hospital Faculty of Medicine Airlangga University Surabaya

Transportation in obstetric critically ill patients is principally identical to transportation in other critically ill patients. There are some discrepancies between them due to anatomical and physiological changes of the mother, as well as the presence of the baby who has to be saved as well. A pregnant woman who is critically ill requires careful observation, considering physiologic changes due to pregnancy. Pregnancy causes marked anatomical and physiological changes in the mother. These adaptations meet the increasing metabolic needs of the foetus and prepare the pregnant woman for parturition. The changes in respiration, circulation and the gut are the most relevant to the obstetric critically ill patients. During pregnancy, oxygen consumption and carbon dioxide production increase by 60 %. Pregnant patients can easily develop hypoxemia. Remember that supine position in at term pregnant women may decrease cardiac output to 40% which in turn generates pre-arrest hypotension or shock. This, in obstetric critically ill patients may precipitate cardiac arrest. Besides, there is an increased regurgitation of gastric contents, which is shown by the high frequency of heartburn in gravidae. Overall, obstetric emergency cases that require transportation are caused by exsanguinations, eclampsia (crisis hypertension, lung edema), heart diseases and infection/sepsis. Like other emergency management, the A-B-C-D systematic, Primary and Secondary Survey are also needed before, during and when the patient arrives at the referral destination. Terminologically, primary transport is known as transportation from the incident site to a medical facility. While secondary transport (inter-hospital) means referring patients to other hospital, usually for an increased level of medical care which is not available locally. Intrahospital transport is noted as movement of patients within the hospital or its campus for investigations or treatments not available at the obstetric ward or intensive care area. (eg CT scan). In the National Health System of the Indonesian Ministry of Health we have the Integrated Emergency Management System (SPGDT Sistem Penanggulangan Gawat Darurat Terpadu), including transportation and referral system. Essential elements in transportation of the critically ill patient, including obstetric cases, are communication, personnel, equipment, monitoring, handling over (documents, information), medico legal and ethical aspects. Air transportation (plane, helicopter) is not included in this presentation due to its distinction from other means of transportations.