8.25 Cardiac Arrest in Pregnancy

Question 1

What is the mnemonic for remember reversible causes of cardiac arrest?

Answer 1

4 Ts and 4 Hs

Question 2

What are the reversible causes of cardiac arrest

Answer 2

• Thrombosis (i.e. PE or MI)
• Tension pneumothorax
• Toxins
• Tamponade (cardiac)
• Hypoxia
• Hypovolaemia
• Hypothermia
• Hyperkalaemia, hypoglycaemia, and other metabolic abnormalities

Question 3

What does RCOG say should be added to the 4Ts and 4Hs to find reversible causes of cardiac arrest?

Answer 3

• Eclampsia

- Intracranial haemorrhage

Question 4

What are the 3 major causes of cardiac arrest in pregnancy?

Answer 4

• Pulmonary embolism
• Obstetric haemorrhage
• Sepsis leading to metabolic acidosis and septic shock

Question 5

Obstetric haemorrhage is a major cause of hypovolaemia, what are 5 causes of massive obstetric haemorrhage?

Answer 5

• Ectopic pregnancy (early pregnancy)
• Placental abruption (including concealed haemorrhage)
• Placenta praevia
• Placenta accreta
• Uterine rupture

Question 6

Why should pregnant women lie on the left lateral position?

Answer 6

to reduce aorto-caval compression

• vena cava compression is most significant and reduces venous return to heart (can cause hypotension or even arrest)

vena cava is slightly to the right so left side is best.

Question 7

What changes are made to resus in pregnancy?

Answer 7

• 15 degree tilt to the left for CPR
• early intubation to protect airway
• early O2
• aggressive fluids (except pre-eclampsia)
• delivery of baby after 4 mins (and then within 5mins) (for mums survival)