1. | Establish invasive hemodynamic monitoring |
• arterial, central line | |
• consider pulmonary arterial catheter | |
• consider PiCCO | |
2. | Provide respiratory support (aim for normoxia) |
• high flow O2 | |
• consider noninvasive ventilation | |
• avoid invasive ventilation if possible | |
3. | Provide hemodynamic support (aim for normal cardiac output) |
• inotropic treatment: dobutamine, levosimendan | |
• vasodilator treatment: intravenous prostacyclin | |
• fluid management | |
4. | Assess ideal timing and mode of delivery |
• urgent/emergent Cesarean based on maternal and fetal assessment | |
5. | Choose ideal anesthetic technique |
• regional anesthesia if possible | |
6. | Continue postoperative monitoring |
• observe for increasing hemodynamic instability | |
• observe for postpartum bleeding | |
7. | Assess ideal anticoagulation timing and agent |
• heparin vs. LMWH |