[Perinatal maternal emergencies]

The perinatal period (from the 28th week of pregnancy to the 28th day after delivery) is a short but special period which endangers the mother's and child's life. There has been no elective statistical assessment of this period but surveys conducted in western countries show that most of the maternal emergencies requiring admission to an intensive care unit are actually those of the perinatal period; some are specific of pregnancy: gravidic toxemia, delivery hemorrhage, acute fatty liver of pregnancy; others such as septic or embolic shock, cardiomyopathy, are found also in non-pregnant women but are favored by pregnancy. Among the numerous eventualities it was necessary to take a selection: ours results from three sorts of considerations: i) the severity of some of these perinatal emergencies: preeclampsia, eclampsia, Hellp syndrome, subcapsula hepatic rupture, septic or hemorrhagic shock are among the most serious ones; ii) the high frequency of some of them: post partum hemorrhage is, in France, the first cause of maternal mortality and the second cause of maternal morbidity whereas infection which can bring a septic shock is found to complicate one to eight per cent of the deliveries; iii) several emergency conditions raise pathophysiological problems which are still not entirely solved, for instance, gravidic toxemia, acute fatty liver of pregnancy, amniotic embolism. They will be especially studied here. Maternal perinatal emergencies remain a major public health problem. It is a necessity to realize the importance of the stakes, to encourage a team spirit, to combine the abilities of obstetricians, intensive care physicians, anaesthesists, echographists, biologists, so that this race against time can be won.