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A - MSRA Obstetrics [16] > [50] Maternal Collapse > Flashcards

[50] Maternal Collapse Flashcards

1
Q

What is maternal collapse?

A

A rare but life threatening event with a wide range of causes

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2
Q

What is maternal collapse defined as?

A

An acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent conscious level at any stage in pregnancy and up to 6 weeks after delivery

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3
Q

What can cause maternal collapse?

A
  • Postpartum and antepartum haemorrhage
  • Thromboembolism
  • Amniotic fluid embolism
  • Cardiac disease
  • Sepsis
  • Drug toxicity/overdose
  • Eclampsia
  • Intracranial haemorrhage
  • Anaphylaxis
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4
Q

This is just to explain how this deck works, just 5 it or delete it after you’ve seen

A

I’ve only done cards in this deck for the causes that aren’t done somewhere else. So the causes of maternal collapse that aren’t in this deck are:

postpartum and antepartum haemorrhage
sepsis (puerperal pyrexia)
thromboembolism
eclampsia

:)

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5
Q

How important is amniotic fluid embolism as a cause of maternal collapse?

A

It is a recognised yet rare cause of maternal collapse, but is often fatal and a direct cause of maternal death

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6
Q

What is the incidence of amniotic fluid embolism?

A

2 in 100,000 pregnancies

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7
Q

What causes amniotic fluid embolism?

A

The cause is still under debate, however possible roles have been attributed to;

  • Strong uterine contractions
  • Excessive amniotic fluid
  • Disruption of vessels supplying the uterus
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8
Q

What are the risk factors for amniotic fluid embolism based on?

A

Abnormalities of the amniotic fluid, uterus, and placenta

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9
Q

What are the risk factors for amniotic fluid embolism?

A
  • Multiple pregnancy
  • Increasing maternal age
  • Induction of labour
  • Uterine rupture
  • Placenta praevia
  • Placental abruption
  • Cervical laceration
  • Eclampsia
  • Polyhydraminos
  • C-section or instrumental delivery
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10
Q

How does amniotic fluid embolism present?

A

Acute onset of;

  • Hypoxia/respiratory arrest
  • Hypotension
  • Fetal distress
  • Seizures
  • Shock
  • Confusion
  • Cardiac arrest
  • DIC
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11
Q

Describe DIC in amniotic fluid embolism

A

May be first sign in some cases, however nearly all patients will develop this within 4 hours

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12
Q

What are the differential diagnoses of amniotic fluid embolism?

A
  • Pulmonary embolism
  • Anaphylaxis
  • Sepsis
  • Eclampsia
  • Myocardial infarction
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13
Q

What investigations should be done in amniotic fluid embolism?

A
  • Bloods
  • ECG
  • CXR
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14
Q

What bloods should be done in amniotic fluid embolism?

A
  • FBC
  • U&E
  • Calcium and magnesium
  • Clotting studies
  • ABG
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15
Q

What might the ECG show in amniotic fluid embolism?

A

Ischaemic changes

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16
Q

What might the CXR show in amniotic fluid embolism?

A

Pulmonary oedema

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17
Q

How can the definitive diagnosis of amniotic fluid embolism be made?

A

Can only be confirmed on post-mortem

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18
Q

How can amniotic fluid embolism be confirmed on post-mortem?

A

Fetal squamous cells are demonstrated along with the debris in the pulmonary vasculature

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19
Q

Who should be contacted if amniotic fluid embolism is suspected?

A

Anaesthetics

20
Q

Why should anaesthetics be contacted in suspected amniotic fluid embolism?

A

They may need to arrange intensive care admission

21
Q

What should the co-ordination of care in amniotic fluid embolism occur alongside?

A

Maternal resuscitation

22
Q

On what basis is the treatment for amniotic fluid embolism?

A

Mainly supportive

23
Q

What approach should be taken to the management of amniotic fluid embolism?

A

A-E

24
Q

What is involved in the A-E management of amniotic fluid embolism?

A
  • High flow oxygen

- Fluids as appropriate

25
Q

What is the purpose of high flow oxygen in the management of amniotic fluid embolism?

A

Minimise neurological compromise

26
Q

What is the purpose of giving fluids in amniotic fluid embolism?

A

To counteract hypotension and haemodynamic instability

27
Q

Who should be involved in the management of DIC in amniotic fluid embolism?

A

Haematologists

28
Q

What should be instigated if the baby is not yet delivered and the patient is relatively stable with amniotic fluid embolism?

A

Continuous fetal monitoring should be started with a view to imminent delivery

29
Q

What should be done if cardiac arrest or maternal compromise occur in amniotic fluid embolism?

A

Peri-mortem section to facilitate CPR of the mother

30
Q

Who do the majority of deaths secondary to cardiac causes occur in?

A

Women with no previous history

31
Q

What are the main causes of maternal cardiac death?

A
  • Myocardial infarction
  • Aortic dissection
  • Cardiomyopathy
32
Q

What are the other causes of maternal cardiac death?

A
  • Dissection of coronary artery
  • Acute left ventricular failure
  • Infective endocarditis
  • Pulmonary oedema
33
Q

When should drug toxicity/overdose be considered as a cause of maternal collapse?

A

Always

34
Q

What should be remembered as a potential cause for maternal collapse outside of hospital?

A

Illicit drug overdose

35
Q

What are the most common sources of maternal therapeutic drug toxicity?

A
  • Magnesium sulphate

- Local anaesthetic agents injected IV by accident

36
Q

When can magnesium sulphate cause toxicity?

A

When given in the presence of renal impairment

37
Q

What toxic effects are initially felt after accidental IV injection of local anaesthetic agents?

A
  • Feeling of inebriation

- Light-headedness

38
Q

What are the initial toxic effects caused by accidental IV injection of local anaesthetic followed by?

A
  • Sedation
  • Circumoral paraesthesia
  • Twitching
39
Q

What are the signs of severe toxicity from the accidental injection of local anaesthetics IV?

A
  • Sudden loss of consciousness, with or without tonic colic convulsions
  • Cardiovascular collapse
40
Q

What causes cardiovascular collapse after IV injection of local anaesthetic agents? q

A
  • Sinus bradycardia
  • Conduction blocks
  • Asystole
  • Ventricular tachycardia
41
Q

What is intracranial haemorrhage?

A

A significant complication of uncontrolled, particularly systolic, hypertension

42
Q

Other than uncontrolled hypertension, what can intracranial haemorrhage result from?

A
  • Ruptured aneurysms

- Arteriovenous malformations

43
Q

What often precedes maternal collapse caused by intracranial haemorrhage?

A

Severe headache

44
Q

What is anaphylaxis?

A

A severe, life-threatening generalised or systemic hypersensitivity reaction, resulting in respiratory, cutaneous, and circulatory changes, and possibly GI disturbance and collapse

45
Q

What are the common triggers for anaphylaxis?

A
  • Drugs
  • Latex
  • Animal allergens
  • Food
46
Q

When what criteria are met is anaphylaxis likely?

A
  • Sudden onset and rapid progression of symptoms
  • Life-threatening airway and/or breathing and/or circulation problems
  • Skin and/or mucosal changes, e.g. flushing, angio-oedema, urticaria
47
Q

For how long after delivery is the risk of blood clots increased?

A

6-8 weeks

A - MSRA Obstetrics [16] (61 decks)

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