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Laura MRCOG Part 2 > 12) Postnatal - Maternal collapse/death > Flashcards

12) Postnatal - Maternal collapse/death Flashcards

1
Q

Incidence of maternal collapse

A

14-600 per 100,000 births

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2
Q

Most common cause of collapse

A

Vasovagal

Post-ictal

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3
Q

Causes of maternal cardiac arrest

A

4Hs:

  • Hypovolemia
  • Hypoxia
  • Hypo/hyperkalaemia
  • Hypothermia

4Ts:

  • Thromboembolism
  • Toxicity
  • Tension pneumothorax
  • Tamponade

Eclampsia + intracranial haemorrhage

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4
Q

Incidence of maternal haemorrhage

A

3.7/1000

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5
Q

Most common cause of cardiac arrest in pregnancy (and other common causes)

A

Haemorrhage (45%)

2) AFE, Heart failure (13%
(3) Anaesthetic complications (8%)
(4) Trauma (3%)

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6
Q

Rate of primary cardiac arrest

A

1/30,000

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7
Q

Incidence of anaphylaxis

A

3-10/1000

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8
Q

Mortality of anaphylaxis

A

1%

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9
Q

Incidence of AFE

A

2/100,000

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10
Q

Mortality of AFE

A

20%

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11
Q

Perinatal mortality of AFE

A

135/1000

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12
Q

How does AFE present?

A

Collapse during labour/delivery/30 minutes of delivery with hypotension, respiratory distress and hypoxia.
Pulmonary hypertension –> left ventricular dysfunction.
Coagulopathy.

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13
Q

Antidote to MgSO4

A

10% 10mL Calcium gluconate

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14
Q

Antidote to LA

A

Intralipid 20% 1.5ml/kg over 1 minute the 0.25ml/kg/min.

Bolus can be repeated x2 and then infusion increased to 0.5ml/kg/min if adequate circulation not restored.

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15
Q

Treatment for anaphylaxis

A

500 micrograms (0.5mL) of 1:1000 IM Adrenaline

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16
Q

Compressions/ventilations during CPR

A

30:2 unless intubated in which case compressions at 100bpm and ventilations 10/minute

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17
Q

Change in plasma volume in pregnancy

A

Increase 50%

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18
Q

Change in heart rate in pregnancy

A

Increase 15-20bpm

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19
Q

Change in cardiac output in pregnancy

A

Increase 40%

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20
Q

What proportion of cardiac output is uterine blood flow?

A

10%

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21
Q

Change in oxygen consumption in pregnancy

A

Increased 20%

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22
Q

Change in residual capacity in pregnancy

A

Reduced 25%

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23
Q

What proportion of circulating volume can be lost by healthy women before becoming symptomatic?

A

35%

24
Q

How often does maternal cardiac arrest occur?

A

1 in 12500 pregnancies

25
Q

Maternal survival after cardiac arrest

A

17-59%

26
Q

Fetal survival after cardiac arrest

A

61-80%

27
Q

What is the effect of aortocaval compression on cardiac output?

A

Reduced up to 60%

28
Q

When should perimortem CS be performed?

A

If no ROSC after 4 minutes of correctly performed CPR in a woman >20 weeks gestation (or uterus at umbilicus or higher) with aim for delivery after 5 minutes of arrest.

29
Q

How to close uterus after PMCS?

A

Use number 1 vicryl.
Upper segment incision in 3 layers - first layer interrupted figure 8 sutures, subsequent can be interrupted or continuous.

30
Q

Blood loss in each of the classes of haemorrhage (as a percentage and as volume in 70kg pregnant woman)

A

Class I: 15%, <1000ml
Class II: 15-30%, 1000-2000ml
Class III: 30-40%, 2000-2700mL
Class IV: >40%, >2700mL

31
Q

Respiratory rate for each class of haemorrhage

A

Class I: 14-20
Class II: 20-30
Class III: 30-40
Class IV: >40

32
Q

HR for each class of haemorrhage

A

Class I: <100
Class II: 100-120
Class III: 120-140
Class IV: >140

33
Q

Blood pressure for each class of haemorrhage

A

Class I: Systolic and diastolic normal
Class II: Systolic normal, diastolic increased
Class III: Systolic and diastolic low
Class IV: Systolic and diastolic low

34
Q

Mental state for each class of haemorrhage

A

Class I: Anxious
Class II: Anxious, confused
Class III: Confused, agitated
Class IV: Lethargic

35
Q

Urine output for each class of haemorrhage

A

Class I: >30
Class II: 15-30
Class III: 5-15
Class IV: Negligible

36
Q

Maternal mortality rate

A

9 per 100,000

37
Q

What percentage of maternal deaths have autopsy?

A

84%

38
Q

Most common type of autopsy for maternal deaths

A

Medico-legal (coronial) autopsy if doctor unable to state cause of death

39
Q

Time period for maternal death

A

6 weeks (42 days)

40
Q

Direct maternal death

A

Disease process specific to pregnancy and delivery (includes suicide + VTE)

41
Q

Indirect maternal death

A

Diseases that also occur in women who are not pregnant but which are exacerbated by pregnancy

42
Q

Coincidental maternal death

A

Diseases unrelated to pregnancy

43
Q

When should cases be reported to a coroner?

A
  • Deceased died in violent or unnatural death
  • Cause of death unknown
  • Deceased died in custody or state detention
44
Q

When should autopsy be done?

A

Next day ideally

45
Q

What is sudden arrhythmic cardiac death syndrome with a morphologically normal heart? (SADS/MNH)

A
  • Acute cardiac arrhythmia and dies
  • Diagnosis of exclusion
  • Suspected secondary to inherited channelopathies
46
Q

Most likely site of embolism

A

left iliac vein

47
Q

Positive autopsy evidence of PET

A

Abnormal spiral arteries in decidua
Abnormal placental histology
Glomerular endotheliosis kidney
Liver periportal haemorrhage (HELLP)

48
Q

Lifetime risk of endocarditis with congenital bicuspid aortic valves

A

10-30%

49
Q

Leading cause of death overall

A

Cardiac

50
Q

Leading cause of indirect death

A

Cardiac

51
Q

Leading cause of direct death

A

VTE

52
Q

Leading cause of direct late deaths

A

Suicide

53
Q

Risk of maternal death based on ethnicity

A

White 7 in 100,000
Asian 13 in 100,000
Mixed 23 in 100,000
Black 38 in 100,000

54
Q

Percentage of women who died who were at severe and multiple disadvantage

A

6%

55
Q

Leading cause of late deaths (overall)

A

Malignancy - coincidental

56
Q

Percentage of maternal deaths known to have pre-existing medical problems

A

67%

Laura MRCOG Part 2 (56 decks)

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