Chapter 16 - Pregnancy

Question 1

List causes of arrest in pregnancy?

Answer 1

PE (#1 medical)

Hemorrhage

PIH

Infection

AFE

Ecclampia

Aortic Dissection

Trauma

Cardiomyopathy

Toxins

Homicide (#1 overall)

Question 2

Describe changes in maternal physiology in pregnancy:

1) Cardiovascular
2) Pulmonary

Answer 2

1) CO increases by 30-40% by 20th week gestation

MAP falls in 1/2TM then returns to baseline in 3TM

Uterus takes about 10% of CO at term

Compression of IVC and Ao means infradiaphragmatic IV access not recommened.

2) Chronic resp alkalosis

Increased MV, TV, RR, O2 use

Decreased FRC

HbF shifted left (stable fetal pO2 as long as materal greater than 60mmHg)

Question 3

What factors make the gravid airway more difficult?

Answer 3

Decreased tolerance of hypoxia

Upper airway edema and friable tissue

Difficult BVM

Decreased FRC

Elevated diaphragm

Increased abdo pressure

Mallapati III more common

Increased BMI

Neck folds

Short neck

Delayed gastric emptying

Decreased LES tone

Question 4

What is optimal position for perfusion in gravid woman?

Answer 4

Supine with right hip elevated 10-12 cm

Head and shoulder elevated into sniffing position

Question 5

What is a normal ABG at term?

Answer 5

7.43/30/102

Question 6

When should a perimortem C/S occur?

Answer 6

Within 5 min of arrest

Question 7

What increases chances of neonate survival following perimortem CS?

Answer 7

Age >28 wk

Wt >1kg

Less time from death to delivery

Maternal death unrelated to hypoxia

Fetus otherwise healthy

NICU available

Good resuscitation effort for mother

Question 8

Pregnancy is an absolute or relative CI to thrombolysis?

Answer 8

Relative.

Has been used in case reports for treatment of PE.

Question 9

How does an AFE present?

What is the treatment?

Answer 9

1) Major - dyspnea, hypotension associated with labor or abortion. May progress to arrest, DIC, MODS

Minor - transient hypoxia and dyspnea that resolves spontaneously

3) Treatment is supportive.