Maternal and Neonatal Emergencies SOP

Question 1

Outline the contents of the Maternal and Neonatal Emergencies SOP

Answer 1

Emergencies occurring during pregnancy up to 6 weeks post-partum

Trauma most common non-pregnancy related cause - overall mortality of 6-7%

Covers:
- Assessment and approach to identify the cause of collapse

• Specific maternal emergencies
  –Obstetric haemorrhage
  – Pre-eclampsia/Eclampsia
  – Epilepsy
  – PE
• Cardiac arrest
• Perimortem section

-Specific intrapartum emergencies
–Cord prolapse
– Breech
– Shoulder dystocia

• Neonatal management as per NLS

Question 2

Outline the approach to assessing the pregnant patient with trauma

Answer 2

CABCDE
Palpate uterus - >20 weeks above umbilicus

Airway:
- early tube
- may need smaller tube

Breathing:
- thoracostomies need to be higher 3/4 IC as diaphragm displaced upwards

Circulation
- MUD
- Assess for haemorrhage
- TXA and blood
- Can use a binder without problems

Question 3

Outline the management of obstetric haemorrhage

Answer 3

Antepartum: Placenta praevia/abruption
Post partum: Tissue/Tone/Thrombin/Trauma

Management
- IVA x2
- Volume resus
- TXA
- Urgent transfer

Consider:
- Fundal massage
- Bimanual compression
- Suturing
- Uterotonics

Question 4

Outline the management of severe pre-eclampsia/eclampsia

Answer 4

• Lateral position
• High flow O2
• No IVI

MgSO4
- 4g IV/IO/IM over 15 mins
- Further 2g if not stopping

• Use benzos
• TCC if considering RSI

Question 5

Outline the management of suspected PE in pregnancy

Answer 5

• Urgent transfer
• Consider thrombolysis
• TCC if consider thrombolysis

Question 6

Outline the management of cardiac arrest in preganancy

Answer 6

Top causes: PE, arrhythmia, haemorrhage, HTN, Sepsis, Amniotic fluid embolism

• MUD
• CPR
• Tube
• Peri-mortem section

Question 7

Discuss peri-portem section/RH

Answer 7

For maternal resuscitation

Aim is to:
- Reduce CO going to uterus
- Relieve aorto-caval compression
- Restore diaphragmatic position
- Improve CPR quality

Indication
- No ROSC after standard ALS for 4 minutes

Equipment
- Scalpel
- Tough cuts
- Maternity kit

Procedure:
- Assign roles
- PPE
- Chlorprep
- Midline incision
- Shears through rectus sheath
- Open peritoneum, push bladder down
- Incise uterus into amniotic sac
- Shears to make incision bigger
- Deliver foetus, hand to NLS team
- Remove placenta and pack
- Compress aorta may help with ROSC

Anticipate bleeding and transport

Question 8

What is the management for cord prolapse?

Answer 8

Relieve compression and transfer

• Minimal handling
• Cover cord with soaked swab
• Lateral/sims position
• Lift pelvis

Question 9

What is the management for breech presentation?

Answer 9

• Lithotomy position
• Pushing
• Encourage arms to be delivered followed by occiput

Question 10

What is the management for shoulder dystocia?

Answer 10

McRobert’s manoeuvre - on the back, legs hyperflexed

Suprapubic pressure - downward, lateral pressure to push the posterior aspect of the anterior shoulder towards the foetal chest