Maternal Collapse Flashcards
What is maternal collapse?
A rare but life threatening event with a wide range of causes
What is maternal collapse defined as?
An acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent conscious level at any stage in pregnancy and up to 6 weeks after delivery
What can cause maternal collapse?
- Postpartum and antepartum haemorrhage
- Thromboembolism
- Amniotic fluid embolism
- Cardiac disease
- Sepsis
- Drug toxicity/overdose
- Eclampsia
- Intracranial haemorrhage
- Anaphylaxis
This is just to explain how this deck works, just 5 it or delete it after you’ve seen
I’ve only done cards in this deck for the causes that aren’t done somewhere else. So the causes of maternal collapse that aren’t in this deck are:
postpartum and antepartum haemorrhage
sepsis (puerperal pyrexia)
thromboembolism
eclampsia
:)
How important is amniotic fluid embolism as a cause of maternal collapse?
It is a recognised yet rare cause of maternal collapse, but is often fatal and a direct cause of maternal death
What is the incidence of amniotic fluid embolism?
2 in 100,000 pregnancies
What causes amniotic fluid embolism?
The cause is still under debate, however possible roles have been attributed to;
- Strong uterine contractions
- Excessive amniotic fluid
- Disruption of vessels supplying the uterus
What are the risk factors for amniotic fluid embolism based on?
Abnormalities of the amniotic fluid, uterus, and placenta
What are the risk factors for amniotic fluid embolism?
- Multiple pregnancy
- Increasing maternal age
- Induction of labour
- Uterine rupture
- Placenta praevia
- Placental abruption
- Cervical laceration
- Eclampsia
- Polyhydraminos
- C-section or instrumental delivery
How does amniotic fluid embolism present?
Acute onset of;
- Hypoxia/respiratory arrest
- Hypotension
- Fetal distress
- Seizures
- Shock
- Confusion
- Cardiac arrest
- DIC
Describe DIC in amniotic fluid embolism
May be first sign in some cases, however nearly all patients will develop this within 4 hours
What are the differential diagnoses of amniotic fluid embolism?
- Pulmonary embolism
- Anaphylaxis
- Sepsis
- Eclampsia
- Myocardial infarction
What investigations should be done in amniotic fluid embolism?
- Bloods
- ECG
- CXR
What bloods should be done in amniotic fluid embolism?
- FBC
- U&E
- Calcium and magnesium
- Clotting studies
- ABG
What might the ECG show in amniotic fluid embolism?
Ischaemic changes
What might the CXR show in amniotic fluid embolism?
Pulmonary oedema
How can the definitive diagnosis of amniotic fluid embolism be made?
Can only be confirmed on post-mortem
How can amniotic fluid embolism be confirmed on post-mortem?
Fetal squamous cells are demonstrated along with the debris in the pulmonary vasculature
Who should be contacted if amniotic fluid embolism is suspected?
Anaesthetics
Why should anaesthetics be contacted in suspected amniotic fluid embolism?
They may need to arrange intensive care admission
What should the co-ordination of care in amniotic fluid embolism occur alongside?
Maternal resuscitation
On what basis is the treatment for amniotic fluid embolism?
Mainly supportive
What approach should be taken to the management of amniotic fluid embolism?
A-E
What is involved in the A-E management of amniotic fluid embolism?
- High flow oxygen
- Fluids as appropriate
