ICU Map

Maternal Critical Illness Rapid Assessment

Urgent maternal stabilization, left uterine displacement, syndromic differentiation, and multidisciplinary escalation.

RecognizeAssessDecideDifferentialInterveneReassess
Critically Ill Pregnant or Postpartum Patient
Assessment StepTrigger: Pregnant (>= 20w) or Postpartum Patient in Shock, Respiratory Failure, Hypertensive Crisis, or SeizureExplore Topic
Immediate Left Uterine Displacement (LUD), high-flow O2, large-bore IV access, arterial line, and fetal heart rate check if viable.
Assessment StepDifferentiate Dominant Maternal Syndrome
Hypertension/Seizure vs Massive Hemorrhage vs Maternal Sepsis vs PE vs PPCM/AFE.
Differential Branches (4)
1Branch
Clinical ActionSevere Preeclampsia / Eclampsia: Magnesium Sulfate + IV Labetalol/Nicardipine
Magnesium 4–6 g load then 1–2 g/h; target BP 140–150/90–100 mmHg; deliver when stabilized.
2Branch
Clinical ActionMassive Postpartum Hemorrhage: Obstetric MTP + TXA 1 g IV + Cryoprecipitate + Uterotonics
TXA within 3 hours (WOMAN trial); maintain fibrinogen > 200 mg/dL; intrauterine balloon tamponade / surgery.
3Branch
Clinical ActionMaternal Septic Shock: 1-Hour Broad-Spectrum Antibiotics (Pip-Tazo + Vanco + Clindamycin)
Norepinephrine for MAP >= 65 mmHg; emergency surgical source control for necrotizing myometritis / chorioamnionitis.
4Branch
Clinical ActionMaternal Cardiac Arrest: ACLS + Manual LUD -> Resuscitative Hysterotomy at Minute 4–5
If no ROSC within 4 minutes in pregnancy >= 20 weeks, perform immediate bedside delivery on site by minute 5.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Performing CPR on a supine pregnant patient without Left Uterine Displacement reduces cardiac output by 40%.
  • Delaying Resuscitative Hysterotomy beyond 4–5 minutes of cardiac arrest drastically reduces maternal and fetal survival.

Related Bedside Clinical Problems (24)

Bedside Presentations
Sudden Hypoxemia

Bedside triage of acute desaturation: signal verification, immediate danger screening (DOPE / tension pneumothorax), oxygen escalation ladder, and mechanism-based differential.

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Sudden Ventilator Deterioration & High Airway Pressures

Algorithmic troubleshooting of acute patient-ventilator collapse: the DOPE framework, peak vs plateau pressure differentiation, auto-PEEP evaluation, and manual bagging separation.

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New or Massive Hemoptysis

Airway preservation and bleeding localization: non-massive vs massive hemoptysis (> 100–200 mL/hr), lateral decubitus positioning, isolation of the bleeding lung, and endovascular/bronchoscopic intervention.

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Linked Deep-Dive Topics (8)

Reference Knowledge
Obstetric Critical Careobstetric

Maternal physiology, preeclampsia/eclampsia, HELLP vs AFLP, postpartum hemorrhage (MTP/TXA), peripartum cardiomyopathy, and arrest.

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Major Bleeding, Hemorrhagic Shock, & Damage Control Resuscitationhematology

The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.

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Acute Pulmonary Embolismrespiratory

Pulmonary vascular occlusion, acute RV pressure overload, ESC/AHA risk stratification, systemic thrombolysis, catheter-directed therapies, and hemodynamic support.

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Sepsisinfectious-disease

Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.

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Cardiogenic Shockcardiovascular

Primary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.

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Disseminated Intravascular Coagulation (DIC) & Sepsis Coagulopathyhematology

Tissue-factor-driven coagulation activation, antithrombin/protein C depletion, PAI-1-associated fibrinolytic suppression, ISTH 2025 DIC assessment, comparison with TTP/HUS/HIT, and targeted replacement.

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Acute Liver Failure (ALF)gi-hepatic

Hyperammonemia, cytotoxic cerebral edema, balanced coagulopathy, N-acetylcysteine, 3% saline neuroprotection, CRRT ammonia clearance, and King's College transplant criteria.

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Cardiac Arrest & Post–Cardiac Arrest Carecardiovascular

Multimodal resuscitation, post-cardiac arrest syndrome management, targeted temperature control, and delayed neuroprognostication.

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