Maternal Collapse Flashcards
What are the differentials for a maternal collapse? (14)
- Vasovagal episode
- High epidural/total spinal block
- Local anaesthetic toxicity
- Haemorrhage
- Hypertensive diseases of pregnancy (eclampsia)
- Pulmonary embolus
- Uterine rupture
- Amniotic fluid embolus
- Cardiac event
- Cerebral event
- Anaphylaxis
- Electrolyte derangement (hypoglycaemia, hyponatraemia)
- Hypovolaemia
- Hypoxaemia
Outline an initial management plan for a maternal collapse
- Call for help
- Position into (L) lateral for uterine displacement
- Apply high flow oxygen
- Assess ABCs
- Commence CPR if no output
- If any seizure activity - needs Magnesium 1gm over 5mins or Midazolam 2mg bolus
- Intubate if required
- Establish IV access
- Apply monitoring
- Treat reversible causes
- O&G review of fetal wellbeing
Outline the management of an eclamptic seizure
- Call for help
- Position (L) lateral
- Apply high flow O2, but don’t bag while seizing
- Terminate seizure with Magnesium 1gm over 5mins, Midazolam 2mg boluses, Propofol or Thiopentone
- Correct any hypotension, hypoxia, hypoglycaemia or electrolyte disturbances
- Establish monitoring
- O&G review of fetal wellbeing
- Commence Magnesium infusion
- Phenytoin load if no response to Magnesium
- Treat hypertension - Nifedipine, Clonidine or Hydralazine
- Neuro assessment once seizure terminated
- Bloods including coags
- Organise appropriate post-event monitoring space
How is a magnesium infusion prepared?
10gm of Magnesium (20mLs 50%) diluted to 50mLs with normal saline (200mg/mL)
Commence at 5mLs/hr (1gm/hr)
Monitor knee jerk reflex, serum Mg level and ECG
Loss of reflexes, hypotension, widening QRS/AV block are signs of toxicity
What is the treatment for Magnesium toxicity?
Calcium chloride
What are the possible causes of hyponatraemia in pregnancy?
- Hyponatraemia of pregnancy related to Osmoreceptor re-set
- Dextrose containing solutions
- Syntocinon (analogue of Vasopressin)
- SIADH
- Pre-eclampsia
What are the presenting signs of amniotic fluid embolism?
- Dysnpoea
- respiratory distress
- cardiovascular collapse
- seizures
- Occ coagulopathy
Outline management of amniotic fluid embolism
No specific management
Supportive care following the management plan for maternal collapse
What are the anaesthetic considerations for a patient with pre/eclampsia?
- Coagulopathy is likely - regional will be contraindicated
- Tight control of blood pressure - needs an IAL and IDC
- Continue Magnesium infusion due to risk of seizure both during and post anaesthesia
- Often significant airway oedema - anticipate a difficult intubation
- Sympathetic response to intubation will exacerbate hypertension - response needs to be blunted (Remifentanil 1mcg/kg bolus, Alfentanil 10mcg/kg bolus, Mag, Esmolol)
- NDMRs will have prolonged effect
- Suxamethonium will no produce fasciculations
- Ergometrine and NSAIDs are contraindicated
- Likely require ICU post-op