DVT, pulmonary embolus & amniotic fluid embolism Flashcards
1
Q
What is Deep vein thrombosis?
A
DVT occurs when a blood clot (thrombus) dorms in one of the deep veins (usually in the legs)
2
Q
What is the role of the midwife with regard to deep vein thrombosis?
A
- collaborative care
- screening for risk
- physical examination
- education (risks, symptoms, antiembolitic stockings)
- encourage ambulation intrapartum and postpartum
- administration of prophylactic anticoagulants
- avoid dehydration
- planning timing of thromboprophylaxis around birth
3
Q
What are the key risk factors for DVT?
A
- previous Hx of thrombosis
- family Hx
- thrombophilia
- maternal age>35
- BMI>30
- smoker
- varicose veins
- diabetes
- cardiac or lung disease
- immobility
- preeclampsia
- Parity>3
- multiple pregnancy
- intrauterine growth restriction
- CS or instrumental
- prolonged labour> 24h
- APH or PPH
- dehydration
- surgery
- stillbirth
- preterm birth
- transfusion
- infection
4
Q
What are the signs/symptoms of DVT?
A
- unilateral redness, swelling or pain in leg
- low grade fever
- prominent superficial veins
pitting oedema - decreased pulse
- difficulty bearing weight
5
Q
Why are pregnant women at increased risk of clotting?
A
- hypercoagulability
- increased venous stasis
- decreased venous outflow
- compression of inferior vena cava and pelvic veins by uterus
6
Q
What is pulmonary embolus?
A
a blockage (usually a clot) of the pulmonary artery that takes blood to the lungs - often a DVT that has travelled
7
Q
What are the signs and symptoms of a pulmonary embolus?
A
- shortness of breath
- chest pain
- cough
- coughing blood
- tachycardia
- sudden hypotension
- collapse
8
Q
What is an amniotic fluid embolism?
A
- rare obstetric emergency
- amniotic fluid enters maternal circulation and causes massive anaphylactic reaction (not IgE mediated) or activates complement cascade
- usually during labour or other procedure
- pathophysiology is poorly understood
9
Q
What are the two phases of amniotic fluid embolism?
A
- pulmonary artery vasospasm, pulmonary hypertension, hypoxia, damage to myocardium and pulmonary capillaries, leading to heart failure and acute respiratory distress
- massive haemorrhage, uterine atony, DIC
10
Q
What are the risk factors for amniotic fluid embolism?
A
- advance maternal age
- placenta praevia
- placental abruption
- operative birth
- induction of labour
11
Q
What are the signs/symptoms of amniotic fluid embolism?
A
- sudden and severe deterioration
- hypotension
- fetal distress
- pulmonary oedema
- cardiopulmonary arrest
- cyanosis
- coagulopathy
- diagnosis is often postmortem
12
Q
What management is possible for amniotic fluid embolism?
A
- resuscitation (intubation, ventilation, cardiopulmonary bypass)
- urgent birth
- coagulation studies
