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
What is the purpose of high flow oxygen in the management of amniotic fluid embolism?
Minimise neurological compromise
What is the purpose of giving fluids in amniotic fluid embolism?
To counteract hypotension and haemodynamic instability
Who should be involved in the management of DIC in amniotic fluid embolism?
Haematologists
What should be instigated if the baby is not yet delivered and the patient is relatively stable with amniotic fluid embolism?
Continuous fetal monitoring should be started with a view to imminent delivery
What should be done if cardiac arrest or maternal compromise occur in amniotic fluid embolism?
Peri-mortem section to facilitate CPR of the mother
Who do the majority of deaths secondary to cardiac causes occur in?
Women with no previous history
What are the main causes of maternal cardiac death?
- Myocardial infarction
- Aortic dissection
- Cardiomyopathy
What are the other causes of maternal cardiac death?
- Dissection of coronary artery
- Acute left ventricular failure
- Infective endocarditis
- Pulmonary oedema
When should drug toxicity/overdose be considered as a cause of maternal collapse?
Always
What should be remembered as a potential cause for maternal collapse outside of hospital?
Illicit drug overdose
What are the most common sources of maternal therapeutic drug toxicity?
- Magnesium sulphate
- Local anaesthetic agents injected IV by accident
When can magnesium sulphate cause toxicity?
When given in the presence of renal impairment
What toxic effects are initially felt after accidental IV injection of local anaesthetic agents?
- Feeling of inebriation
- Light-headedness
What are the initial toxic effects caused by accidental IV injection of local anaesthetic followed by?
- Sedation
- Circumoral paraesthesia
- Twitching
What are the signs of severe toxicity from the accidental injection of local anaesthetics IV?
- Sudden loss of consciousness, with or without tonic colic convulsions
- Cardiovascular collapse
What causes cardiovascular collapse after IV injection of local anaesthetic agents? q
- Sinus bradycardia
- Conduction blocks
- Asystole
- Ventricular tachycardia
What is intracranial haemorrhage?
A significant complication of uncontrolled, particularly systolic, hypertension
Other than uncontrolled hypertension, what can intracranial haemorrhage result from?
- Ruptured aneurysms
- Arteriovenous malformations
What often precedes maternal collapse caused by intracranial haemorrhage?
Severe headache
What is anaphylaxis?
A severe, life-threatening generalised or systemic hypersensitivity reaction, resulting in respiratory, cutaneous, and circulatory changes, and possibly GI disturbance and collapse
What are the common triggers for anaphylaxis?
- Drugs
- Latex
- Animal allergens
- Food
When what criteria are met is anaphylaxis likely?
- Sudden onset and rapid progression of symptoms
- Life-threatening airway and/or breathing and/or circulation problems
- Skin and/or mucosal changes, e.g. flushing, angio-oedema, urticaria
For how long after delivery is the risk of blood clots increased?
6-8 weeks
