Maternal collapse

Question 1

In pregnancy, the respiratory rate increase, what are the implications of this?

Answer 1

decreased buffering capacity therefore acidosis more likely

Question 2

If pregnant mum needs CPR, what might you need to consider?

Answer 2

increased CPR demand due to increased heart rate and cardiac output

Question 3

Why is there a huge risk for bleeding in pregnancy?

Answer 3

10% cardiac output diverted to uterine blood flow

Question 4

How does an increased in plasma volume impact on resus in pregnancy?

Answer 4

dilutional anaemia + reduced oxygen carrying capacity

Question 5

Why is there an increased risk of aspiration in pregnant resus?

Answer 5

reduced gastric motility and relaxed lower oesophageal sphincter

Question 6

Why might intubating during pregnancy be difficult?

Answer 6

enlarged uterus (diaphragmatic splinting) + increased weight (breasts)

Question 7

When should perimortem c-section be performed?

Answer 7

if no response to CPR after 4 mins and utereus approx 20 weeks

Question 8

What are the 4 H’s and T’s?

Answer 8

hypoxia
hypovolaemia
hypo/hyperkalaemia
hypothermia

thromboembolism
toxic
tamponade
tension pneumo

Question 9

What else should be considered in collapse aside from 4H’s+ T’s?

Answer 9

eclampsia (including magnesium toxicity)

amniotic fluid embolism

Question 10

List four differentials for maternal collapse

Answer 10

eclampsia- intracranial haemorrhage
PE
Amniotic fluid embolism
Haemorrhage
Drugs
Anaphylaxis
Aortic dissection 
cardiac causes- arrrhythmia, cardiomyopathy
hypoglycaemia
sepsis

Question 11

Where can embolus arise from in pregnancy

Answer 11

amniotic fluid
pulmonary
air embolus
MI