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Special article
Available online 4 May 2024
Critical pregnancy at altitude: A look at Latin America
Embarazo crítico en la altitud: una mirada en América Latina
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Adrián Avila-Hilaria, Amilcar Tinoco-Solórzanob, Jorge Vélez-Páezc, Manuel Luis Avellanas-Chavalad,
Corresponding author
mlavellanas@gmail.com

Corresponding author.
, on behalf of Comité de Expertos de Medicina Crítica en la Altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva (FEPIMCTI)
a Unidad de Terapia Intensiva, Hospital Municipal Boliviano Holandés, El Alto, Bolivia
b Servicio de Cuidados Intensivos e Intermedios, Seguro Social de Salud (EsSalud), Hospital Nacional Ramiro Prialé Prialé, Huancayo, Perú
c Unidad de Terapia Intensiva, Hospital Pablo Arturo Suárez, Quito, Ecuador
d Médico Especialista en Medicina Intensiva, Huesca, España
This item has received
Received 20 February 2024. Accepted 24 March 2024
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Figures (1)
Tables (3)
Table 1. Population living in high altitude.1
Table 2. Location and altitude of Intensive Care Units in Latin America at 2500 masl.
Table 3. Evolution of mean arterial blood gas test values reported for the 3rd trimester of pregnancy from sea level up to 4300 masl.
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Abstract

Critical pregnancy at high altitudes increases morbidity and mortality from 2500 m above sea level. In addition to altitude, there are other influential factors such as social inequalities, cultural, prehospital barriers, and lack the appropriate development of healthcare infrastructure. The most frequent causes of critical pregnancy leading to admission to Intensive Care Units are pregnancy hypertensive disorders (native residents seem to be more protected), hemorrhages and infection/sepsis. In Latin America, there are 32 Intensive Care Units above 2500 m above sea level. Arterial blood gases at altitude are affected by changes in barometric pressure. The analysis of their values provides very useful information for the management of obstetric emergencies at very high altitude, especially respiratory and metabolic pathologies.

Keywords:
Altitude
Pregnancy
Maternal critical care
Intensive care
Obstetrics
Maternal morbidity
Maternal mortality
Resumen

El embarazo crítico en la alta altitud aumenta su morbimortalidad a partir de los 2.500 metros sobre el nivel del mar. Además de la altitud, existen otros factores influyentes como las desigualdades sociales, las barreras culturales, prehospitalarias y falta de desarrollo adecuado de las infraestructura sanitarias. Las causa más frecuentes del embarazo crítico que motivan el ingreso en las Unidades de Medicina Intensiva son los trastornos hipertensivos del embarazo (las residentes nativas parecen estar más protegidas), las hemorragias y la infección/sepsis. En Latinoamérica hay 32 Unidades de Medicina Intensiva a partir de los 2.500 msnm. La gasometría arterial en la altitud se ve afectada por los cambios de la presión barométrica. El análisis de sus valores proporciona una información muy útil para el manejo de las emergencias obstétricas a muy alta altitud, especialmente de las patologías respiratorias y metabólicas.

Palabras clave:
Altitud
Embarazo
Cuidados críticos maternos
Cuidados intensivos
Obstetricia
Morbilidad materna
Mortalidad materna

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