Maternal Collapse Flashcards
leading cause of maternal mortality in labour and 6 weeks following?
cardiac (indirect)
main direct cause of maternal death?
venous thromboembolism
general principles of management of emergency?
anticipation and preparation are essential (prevent collapse/arrest etc)
two lives at stake but mum is 1st
get help early
ABCDE
human factors and communication training essential
counselling and debrief for patient and staff
MEWS?
maternal early warning score
1 red or 2 amber scores = medical review
what can cause collapse (5 Hs)?
head
- eclampsia, epilepsy, cerebrovascular accident
heart
- MI, arrhythmia, paripartum cardiomyopathy
hypoxia
- asthma, PE, pulmonary oedema, anaphylaxis
haemorrhage
- abruption, atony, trauma, uterine rupture, uterine inversion, ruptured aneurysm
whole body and hazzards
- hypoglycaemia, septicaemia, trauma, anaesthetic complications, drug overdose
emergency bloods?
FBC cross match coagulation U&Es lactate glucose ......
risks to be aware of when resuscitating pregnant woman?
gravid uterus
- can cause aortocaval compression and can also make ventilation difficult due to pressure on diaphragm
foetus and placenta steal oxygen and circulation from mother (20% decrease in pulmonary functional residual capacity and 20% increase in oxygen consumption increasing risk of hypoxia)
more likely to aspirate (increased prostaglandins loosen muscles/sphincters including oesophageal
more difficult to intubate
what is aortocaval compression?
from 20 weeks gestation (or as soon as visibly pregnant), the uterus can compress IVC and aorta when lying on back reducing venous return
decreases cardiac output up to 40% causing supine hypotension
how is
mrs MUD
- manual uterine displacement (push the bump over to the left hand side)
causes of cardiac arrest (4 Hs and 4 Ts)?
hypothermia
hypotension
hypokalaemia
hypoxia
thrombosis
tamponade
toxins
tension pneumothorax
Pre-eclampsia in pregnancy
how long should CPR be continued before emergency (peri-mortem) C section is performed?
4 mins
how is a perimortem C section performed?
very basic, fast, non-sterile C section done in emergency
basically just slice open with a scalpel
CPR continued throughout
which rhythms are shockable?
VF
VT
specific drug treatment for collapse in pregnancy?
cardiac arrest = 1mg adrenaline every 2 mins
VF/VT = 300mg amiodarone
opiate overdose = 0.4-0.8mg naloxone
magnesium toxicity = 1g calcium gluconate
local anaesthetic toxicity = 1.5ml 20% intralipid
when is magneisum sulphate given?
pre-term delivery = to foetus
seizure (eclampsia) = to mum
management of seizure?
call for help make patient safe note time and length of seizure give high flow oxygen don't restrain patient get IV access move patient into left lateral position and open airway monitor baby declare status if >5 mins give magnesium sulphate
how is anaphylaxis managed?
remove allergen sit up high flow oxygen IM adrenaline 500mcg every 5 mins and IV crystalloid bolus (main initial management) chlorpheniramine 20mg IV hydrocortisone 200mg IV salbutamol neb
how is hypoglycaemia managed?
<3mmol = 50ml of 10% dextrose ivor 1mg glucagon IM or glucogel
stop insulin
diagnostic criteria for DKA?
ketones > 3mmol/L
blood glucose > 11mmol/L
venous bicarbonate <15mmol/L or venous pH <7.3
how is DKA managed?
fluid replacement saline insulin therapy locate and treat cause monitor ABGs and baby - deliver if mum is stable
what is an amniotic fluid embolism?
amniotic fluid enters maternal circulation causing collapse +/- arrest
how does amniotic fluid embolism present?
profound foetal distress sudden resp distress seizure DIC increased zinc coproporphyrin levels squames seen on right sided circulation
how is amniotic fluid embolism managed?
supportive ITU
can you thrombolyse in pregnancy?
yes
only if necessary as can cause risk to foetus and increased risk of PPH
what is cord prolapse and what are the risks?
prolapse of the umbilical cord out of the uterus (can even protrude out of the vagina)
can cause direct compression and cord spasm leading to decreased flow to foetus resulting in hypoxia and death
how can cord prolapse be prevented?
ensure head is engaged before rupturing amniotic membranes
management of cord prolapse?
obstetric emergency
immediate delivery (category 1)
tocolytic and maternal positions to relieve pressure
what is shoulder dystocia?
any cephalic delivery where manoeuvres other than gentle traction are required to deliver baby after the head has been delivered
bony impaction of the foetal anterior shoulder on the maternal symphysis
risk factors for shoulder dystocia?
obesity diabetes macrosomnia prolonged labour instrumental delivery
signs of shoulder dystocia?
slow delivery of the head, face and chin
turtling of the head against perineum
lack of restitution
head bobbing (head retracts back inside between contractions)
