Antenatal Care - Cardiac Arrest in Pregnancy

Question 1

Aetiology of Cardiac Arrest in Pregnancy (3).

Answer 1

1. Obstetric Haemorrhage (Severe Hypovolaemia).
2. PE.
3. Sepsis - Metabolic Acidosis and Septic Shock.

Question 2

Aetiology of Obstetric Haemorrhage (5).

Answer 2

1. Ectopic Pregnancy.
2. Placental Abruption (including Concealed Haemorrhage).
3. Placenta Praevia.
4. Placenta Accrete.
5. Uterine Rupture.

Question 3

What is Aortocaval Compression?

Answer 3

1. Uterus is a significant size after week 20.
2. Mass of Uterus compresses the IVC (more) and Aorta when supine.
3. Reduced CO - Hypotension - Potentially Cardiac Arrest.

Question 4

How can Aortocaval Compression be relieved?

Answer 4

Left Lateral Position - uterus positioned away from IVC to improve venous return and CO.

Question 5

Additional Considerations in Resuscitation (5).

Answer 5

1. Early Supplementary Oxygen.
2. Early Intubation to Protect Airway.
3. Aggressive Fluid Resuscitation (not PET).
4. 15 Degree Tilt to Left Side (Aortocaval Compression).
5. Delivery after 4 minutes and within 5 minutes of starting CPR.

Question 6

Indications of Immediate C-Section in Cardiac Arrest (2).

Answer 6

1. No Response After 4 Minutes to Correct CPR.

2. CPR continues for 4+ minutes in a woman of 20+ weeks gestation.

Question 7

Why is Immediate Delivery indicated?

Answer 7

Improve survival of the mother - delivery improves venous return and and CO and reduces Oxygen consumption (though it also does increase chances of foetus survival).