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Reproduction and sexual health > Maternal collapse > Flashcards

Maternal collapse Flashcards

1
Q

What should you do if a heavily pregnant woman collapses and is lying on her back? and why?

A

check for danger and call for help

She should be rolled into the left lateral position to avoid aortocaval compression causing vasovagal syncope

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2
Q

What are direct causes of maternal death

A

VTE, PPH, pulmonary oedema

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3
Q

What are indirect causes of maternal death

A

cardiac arrest

mental health conditions

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4
Q

Whose life do you have to save first, the mother or the baby

A

Mother, otherwise you cant save the baby

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5
Q

Who should you ask for when you call 2222/999

A

maternity team + arrest team

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6
Q

What is maternal collapse a sign of

A

respiratory or cardiac distress

may range from syncope to cardiac arrest

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7
Q

What are the reversible causes of cardiac arrest

4H’s + 4T’s

A 
Hypoxia 
Hypovolaemia 
Hypothermia 
Hyper/Hypokalaemia 
Pre eclampsia 
Toxins 
Tension pneumothorax 
Tamponade 
Thromboembolic disease - amniotic fluid embolism
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8
Q

What emergency bloods should you ask for

A 
FBC 
U+E 
LFT 
lactate 
cultures 
ABG 
Crossmatch 
GLUCOSE
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9
Q

What level of glucose is bad

A

<4 to the floor

Treat!

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10
Q

Who is Mrs MUD

A

All pregnant women

Manual Uterine Displacement

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11
Q

When is Mrs MUD done

A

during resuscitation and CPR

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12
Q

After how many minutes of CPR should a baby be delivered, do you need to go to theatre?

A

4 minutes - decision made / prepare for peri-mortem c-section
5 minutes - baby is out
No, can be done there and then with just a scalpel

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13
Q

Can CPR continue whilst you deliver the baby at 4 min

A

Yes

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14
Q

What medication do you give in cardiac arrest

A

1 mg Adrenaline every 2 min

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15
Q

What medication do you give for VF/VT

A

300mg amiodarone

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16
Q

What are the shockable rhythms

A

VF and pulseless VT

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17
Q

What are the NON shockable rhythms

A

PEA and asystole

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18
Q

What medication is given in opioid overdose

A

0.4-0.8mg naloxone

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19
Q

What medication is given for magnesium sulphate overdose

A

1g Calcium gluconate

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20
Q

What medication is given for local anaesthetic overdose

A

1.5ml 20% Intralipid

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21
Q

How do you manage an eclamptic seizure

A 
call for help 
make patient safe - remove objects that could cause harm 
record timing and duration 
after seizure - give:
high flow O2
left lateral position 
open airway 
monitor baby
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22
Q

What is happening after 5 minutes of seizure

A

status epilepticus

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23
Q

Management of anaphylaxis

A 
remove allergen 
high flow O2 
IM adernaline every 5 minutes 
IV crystalloid bolus 
IV chlopheniramine 
IV hydrocortisone 
Neb salbutamol
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24
Q

Pregnant women may be normoglycaemic in DKA, true or false

A

TRUE

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25
Q

Signs + Management of amniotic fluid embolism

A 
supportive and intensive care 
foetal distress 
resp distress 
DIC 
seizure 
Increased Zn coproporphyrin levels 
Clinical diagnosis largely
26
Q

Can you thrombolyse a pregnant women with a massive PE

A

Yes with heparin

27
Q

how severe is cord prolapse

A

obstetric emergency

causes direct compression and cord spasm - hypoxia and death

28
Q

Features of cord prolapse

A 
malpresentation 
pre term 
ruptured membranes 
2nd twin 
may or may not see cord come down
29
Q

How soon should a baby be delivered if there is cord prolapse

A

ASAP - category 1 c-section

30
Q

What should always be done before artificial rupture of membranes ARM

A

Palpate the abdomen to ensure the head is engaged and avoid a cord prolapse

31
Q

Shoulder dystocia is an obstetric emergency, true or false

A

TRUE

32
Q

What is the management of shoulder dystocia

A 
HELPERR 
H - Help 
E - consider Episiotomy
L - Legs in McRoberts manoeuvre 
P - external suprapubic Pressure
E - Enter vagina with internal pressure 
R - Remove posterior arm 
R - Rotate mother on all fours
33
Q

What are the 5 H’s that cause maternal collapse

A 
Head 
Heart 
Hypoxia 
Haemorrhage 
wHole body and Hazards
34
Q

Head: causes of collapse

A

eclampsia
epilepsy
cerebrovascular incident
vasovagal response

35
Q

Heart: causes of collapse

A

MI
arrythmias
peripartum cardiomyopathy

36
Q

Hypoxia: causes of collapse

A

asthma
PE
pulmonary oedema
anaphylaxis

37
Q

Haemorrhage: causes of collapse

A 
uterine rupture
placental abruption 
atony 
trauma 
ruptured aneurysm
38
Q

wHole body and Hazards: causes of collapse

A 
hypoglycaemia 
amniotic fluid embolism 
sepsis 
trauma 
anaesthetic complications
drug overdose
39
Q

why is it harder to resuscitate a pregnant woman

A

pregnant uterus causes aortocaval compression
pressure on diaphragm causes ventilation difficulty
foetus “steals” oxygen therefore at more risk of hypoxia
more likely to aspirate due to hormonal relaxation of oesophageal sphincters
more difficult to intubate

40
Q

As soon as infant is delivered, vena cava returns to normal and cardiac output is restored
True or false

A

TRUE

41
Q

How do you do MUD

A

Keep mother in supine position and apply left MUD to displace uterus to relieve pressure on aorta and vena cava which improves venous return to the heart

42
Q

What should be ensured when an AED indicates shock

A

ensure no one is touching the patient

ensure oxygen mask is far away

43
Q

When do you give adrenaline in cardiac arrest with shockable rhythms

A

1mg adrenaline should be given after the 3rd shock with defibrillator and then every other cycle (every 4 minutes)

44
Q

When should amiodarone be given in cardiac arrest with shockable rhythms

A

after the 3rd shock with the defibrillator

45
Q

When should adrenaline be given in non-shockable rhythms

A

every 3-5 minutes

46
Q

Signs of massive PE in a pregnant woman

A 
raised JVP
enlarged liver 
parasternal heave 
fixed splitting of 2nd heart sound 
\+- evidence of DVT
47
Q

What is shoulder dystocia

A

any cephalic presentation where manoeuvres other than gentle traction are required to deliver the baby after the head has been delivered
bony impaction of foetal anterior shoulder on maternal pubis symphysis

48
Q

What signs can be seen in shoulder dystocia

A

head bobbing

turtle sign

49
Q

in which position should pregnant women be assessed

A

left lateral position

50
Q

what systems can you use in the assessment of maternal collapse

A

ABCDE

primary obstetric survey / PROMPT - starts at the head and works downwards

51
Q

describe the PROMPT assessment

A

head - AVPU, responsive
heart - CRT, pulse, BP, murmur
chest - air entry, RR, O2 sats, breath sounds, trachea central
abdomen - rebound, guarding, tenderness, foetus alive?
Vagina - bleeding, stage of labour, inverted uterus
legs - sign of DVT

52
Q

what interventions can you make if the cause of maternal collapse is not obvious

A

fluid resuscitation
? laparotomy
Sepsis 6?
intensive care?

53
Q

contraindications to fluid resuscitation

A

pulmonary oedema as a result of severe pre-eclampsia or renal failure

54
Q

what is the secondary survey

A

take a history / revisit history
read notes / ask relatives
examine from top to toe again
investigations: ABG, troponin, glucose, lactate, ECG, CXR, USS, high vaginal swab

55
Q

causes of maternal collapse 5H’s

A 
Head 
Heart 
Hypoxia 
Haemorrhage 
wHole body and Hazards
56
Q

potential causes of maternal collapse: HEAD

A 
eclampsia 
epilepsy 
CVA 
intracranial haemorrhage 
vasovagal response
57
Q

potential causes of maternal collapse: HEART

A 
MI 
arrythmias 
peripartum cardiomyopathy 
congenital heart disease 
thoracic aortic dissection
cardiac arrest
58
Q

potential causes of maternal collapse: HYPOXIA

A

asthma
PE
pulmonary oedema
anaphylaxis

59
Q

potential causes of maternal collapse: HAEMORRHAGE

A 
placental abruption 
uterine atony 
genital tract trauma 
uterine rupture 
uterine inversion 
ruptured aneurysm
60
Q

potential causes of maternal collapse: wHole body and Hazards

A 
hypoglycaemia 
amniotic fluid embolus 
sepsis 
trauma 
complications of anaesthesia 
anaphylaxis
61
Q

management of uterine atony as a cause of PPH

A

expel clots and massage uterus
IV access + bloods: FBC, coagulation, cross match
IV fluids
uterotonics - syntocin/ergometrine/carboprost
tranexamic acid
urinary catheter

Reproduction and sexual health (46 decks)

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