Maternal Collapse

Question 1

maternal death rate in UK

Answer 1

10/100,000

Question 2

most common cause of maternal death 6 weeks after birth

Answer 2

cardiac disease (indirect cause) 
VTE (direct cause)

Question 3

general principles of obstetric emergency treatment

Answer 3

anticipate - look for risk factors
mum comes first
get help early - maternity emergency bleep/maternity cardiac arrest team
ABCDE
declare the emergency
after- counselling and debrief patient, partners and staff

Question 4

what is MEWS

Answer 4

maternal early warning score

NEWS but for obstetric patients

Question 5

what are some causes of maternal collapse (5Hs)

Answer 5

Head - eclampsia, epilepsy, cerebrovascular accident, vasovagal response
Heart- MI, arrhythmia, peripartum cardiomyopathy
Hypoxia
Haemorrhage
wHole body and hazards

Question 6

what is aortocaval compression

Answer 6

move the bump out of the way - gravid uterus compresses the IVC and aorta reducing venous return

Question 7

what is aortocaval compression

Answer 7

move the bump out of the way - gravid uterus compresses the IVC and aorta reducing venous return

need LEFT uterine displacement

Question 8

what are the 4Hs and 4Ts of cardiac arrest

Answer 8

Hypothermia
Hypokalaemia/other hypo/hyper metabolic causes
Hypovolaemia
Hypoxia

Thrombosis
Toxins
Tamponade
Tension pneumothorax

Question 9

hold long into a cardiac arrest do you need to deliver the baby

Answer 9

prepare 4 minutes

perimortum c-section makes it more likely for mum to survive

baby should be delivered at 5 mins

no blood because the mother is dead

Question 10

what rhythms are shockable

Answer 10

VF

VT

Question 11

when do you give magnesium

Answer 11

to baby in pre-term delivery (protective against cerebral palsy

to mum in seizures (eclampsia)

Question 12

how do you treat eclampsia/seizure

Answer 12

call for help
make patient safe
note time and length (>5mins - status epileptics)
Dont restrain
get IV access
after move into left lateral position and make sure airways open

Question 13

how do you treat anaphylaxis in pregnant ladies

Answer 13

remove allergen 
high flow oxygen 
dont lie flat 
IM adrenaline 500mcg every 5 mins and iV crystalloid bolus 
Chlorpheniramine 20mg IV 
Hydrocortisone 200mg IV 
Salbutamol neb

Question 14

how do you treat hypoglycaemia in pregnancy

Answer 14

<3mmol/l 
give 50ml of 10% dextrose 
Img glucagon IM 
Glucogel 
stop insulin

Question 15

what is an amniotic fluid embolism

Answer 15

v rare
usually in labour
amniotic fluid enters maternal circulation - collapse/+/- cardiac arrest
need intensive care unit
Zinc coproprophyryn levels increased
diagnosis can be confirmed on post-mortem

Question 16

how do you treat massive PE in pregnancy

Answer 16

you can thrombolyse in pregnancy - mum comes first

Question 17

what is cord prolapse

Answer 17

membranes have ruptured and cord comes down through the cervix

direct compression of the cord leads to hypoxia and death

scan for fetal cardiac activity

immediate delivery (category 1- CS or forceps)

tocolytic and maternal positions to relieve pressure (get them on all 4s)

Question 18

prevent cord prolapse

Answer 18

dont rupture membranes unless head is engaged in the pelvis

Question 19

what is shoulder dystocia

Answer 19

baby has crowned but the shoulder is stuck behind the pubic bone