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. 2022 Apr;117(3):239-252.
doi: 10.1007/s00063-022-00910-y.

[Internal medical emergencies in the pregnant patient : Peripartum sepsis, metabolic derailment, endocrinological emergencies and pulmonary edema]

[Article in German]
J Fischer, G Gerresheim, U Schwemmer  1
Affiliations

[Internal medical emergencies in the pregnant patient : Peripartum sepsis, metabolic derailment, endocrinological emergencies and pulmonary edema]

[Article in German]
J Fischer et al. Med Klin Intensivmed Notfmed. 2022 Apr.

Abstract
in English, German

Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in pregnant women symptoms can be masked and the initiation of treatment is delayed. Peripartum sepsis has a relatively high incidence. The anti-infective treatment depends on the spectrum of pathogens to be expected. Endocrinological emergencies are rare but can be fulminant and fatal. The development of ketoacidosis is favored by decreased bicarbonate buffer and placental hormones. In the case of thyrotoxicosis, propylthiouracil and thiamazole are available for treatment depending on the stage of gestation. Sheehan's syndrome is an infarction of the anterior lobe of the pituitary gland during a hemorrhage. Due to the loss of production of vital hormones, this can be fatal. The development of pulmonary edema is just as acute. This is favored by physiological changes during pregnancy. The differentiation between hypertensive and hypotensive pulmonary edema is important for the causal treatment.

Peripartale Notfälle, die intensivmedizinisch behandelt werden müssen, stellen eine große Herausausforderung an das interdisziplinäre Behandlungsteam dar. Aufgrund physiologischer Veränderungen der Schwangeren können Symptome maskiert und eine Therapieeinleitung verzögert werden. Die peripartale Sepsis weist eine relativ hohe Inzidenz auf. Die antiinfektive Therapie richtet sich nach dem zu erwartenden Keimspektrum. Endokrinologische Notfälle sind selten, können jedoch fulminant und tödlich sein. Die Entstehung einer Ketoacidose wird durch erniedrigte Bikarbonatpuffer und Plazentahormone begünstigt. Im Rahmen einer Thyreotoxikose stehen zur Therapie Propylthiouracil und Thiamazol in Abhängigkeit vom Gestationszeitpunkt zur Verfügung. Das Sheehan-Syndrom ist eine Infarzierung des Hypophysenvorderlappens im Rahmen einer Hämorrhagie. Durch Produktionsausfall lebenswichtiger Hormone kann dieses letal enden. Ebenso akut ist die Entstehung eines Lungenödems. Dieses wird durch physiologische Veränderungen während der Schwangerschaft begünstigt. Kausal ist für die Therapie die Unterscheidung eines hyper- oder hypotensiven Lungenödems von Bedeutung.

Keywords: Ketoacidosis; Pregnancy; Puerperal mortality; Sheehanʼs syndrome; Thyrotoxicosis.

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