Antenatal Care - Cardiac Arrest in Pregnancy

Question 1

Reversible Causes of Cardiac Arrest (4+4).

Answer 1

4Ts :
1. Thrombosis.
2. Tension Pneumothorax.
3. Toxins.
4. Tamponade (Cardiac).

4Hs :
1. Hypoxia.
2. Hypovolaemia.
3. Hypothermia.
4. Hyperkalaemia, Hypoglycaemia & Other Metabolic Abnormalities.

Question 2

Additional Pregnancy-Related Reversible Causes of Cardiac Arrest (2).

Answer 2

1. Eclampsia.
2. Intracranial Haemorrhage.

Question 3

Commonest Causes of Cardiac Arrest in Pregnancy (3).

Answer 3

1. Obstetric Haemorrhage (Hypovolaemia).
2. Pulmonary Embolism.
3. Sepsis - Metabolic Acidosis & Septic Shock.

Question 4

Causes of Massive Obstetric Haemorrhage (5).

Answer 4

1. Ectopic Pregnancy.
2. Placental Abruption.
3. Placenta Praevia.
4. Placenta Accreta.
5. Uterine Rupture.

Question 5

Aortocaval Compression (3*).

Answer 5

1. After Week 20 : Uterus is massive.
2. Supine position : Uterus compresses IVC and Aorta.
3. Reduces Venous Return (IVC) –> Hypotension –> Loss of CO.
   * Solution : Left Lateral Position (since IVC is on Right Side).

Question 6

Additional Measures in Resuscitation (4).

Answer 6

1. 15 Degree Tilt to Left Side for CPR (Aortocaval Compression).
2. Early Intubation and Supplementary Oxygen.
3. Aggressive Fluid Resuscitation (be careful in PET).
4. Delivery of the Baby after 4 Minutes and within 5 Minutes of Starting CPR.

Question 7

Delivery in Cardiac Arrest (2).

Answer 7

1. Immediate C-Section if no response after 4 minutes.
2. Improve survival of mother.