Title: Simple tips for managing the critically-Ill pregnant patient
题目：治疗病危怀孕患者的简单技巧
Author 作者: Haney Mallemat

The pregnant patient normally has increased cardiac output and minute ventilation by the third trimester. Despite this increase, however, these patients have little cardiopulmonary reserve should they become critically-ill.
孕妇患者通常在孕晚期出现心输出量和每分钟通气量增加。然而，尽管这样，他们一旦患重病，其心肺功能储备都不够。
Remember the mnemonic T.O.L.D.D. for simple tips that should be done for the pregnant patient who presents critically-ill or with the potential for critical illness: 
在治疗病危或有发生病危倾向的孕妇时，要记住这个简单的助记口诀T.O.L.D.D.：
Tilt: The supine-hypotension syndrome occurs after the 20th week of pregnancy as the gravid uterus compresses the IVC and aorta, reducing cardiac output by up to 30%. Placing a 30-degree right hip-wedge under the patient will relieve this obstruction.
倾斜：仰卧位低血压综合征通常在怀孕20周后，由于妊娠子宫压迫下腔静脉和主动脉，心输出量减少高达30％ 。在右髋放置一个30度的楔形物将缓解这一压迫。
Oxygen: the growing uterus pushes up on the base of the lungs reducing the functional residual capacity meaning there is less oxygen reserve and rapid oxygen desaturations. Supplemental oxygen may increase the patient's reserve.
氧气：不断增大的子宫将肺底部向上推移，降低肺部功能残气量，使氧气储备减少和氧饱和度下降加快。补充氧气可能会增加病人的储备。

Lines: The circulatory system reserve is reduced, so early and large bore venous access is important. Remember that lines should be placed above the diaphragm because the enlarging uterus compresses pelvic veins, reducing venous return to the heart.
静脉通路：由于循环系统储备减少，所以早期大口径静脉通路是非常重要的。请记住静脉通路应放在横膈膜以上的位置，因为扩大的子宫压压迫盆腔静脉，减少（下肢）静脉血回流到心脏。

Dates: Rapidly determine the gestational age of the fetus as 24 weeks is a critical date to remember (e.g., increased risk of supine-hypotension syndrome, fetal viability, etc.)
日期：迅速确定胎龄，因为24周的胎龄是一个关键的数字要记得（例如，仰卧位低血压综合征的风险增加，胎儿已有生存能力等）
Delivery: Call labor and delivery early on, not only for the consultation, but also for the fetal monitoring that this service provides. 
分娩：尽早联系产房，不仅仅是为了会诊，同时也要提供胎儿监护。