Maternal collapse Flashcards
What should you do if a heavily pregnant woman collapses and is lying on her back? and why?
check for danger and call for help
She should be rolled into the left lateral position to avoid aortocaval compression causing vasovagal syncope
What are direct causes of maternal death
VTE, PPH, pulmonary oedema
What are indirect causes of maternal death
cardiac arrest
mental health conditions
Whose life do you have to save first, the mother or the baby
Mother, otherwise you cant save the baby
Who should you ask for when you call 2222/999
maternity team + arrest team
What is maternal collapse a sign of
respiratory or cardiac distress
may range from syncope to cardiac arrest
What are the reversible causes of cardiac arrest
4H’s + 4T’s
Hypoxia Hypovolaemia Hypothermia Hyper/Hypokalaemia Pre eclampsia Toxins Tension pneumothorax Tamponade Thromboembolic disease - amniotic fluid embolism
What emergency bloods should you ask for
FBC U+E LFT lactate cultures ABG Crossmatch GLUCOSE
What level of glucose is bad
<4 to the floor
Treat!
Who is Mrs MUD
All pregnant women
Manual Uterine Displacement
When is Mrs MUD done
during resuscitation and CPR
After how many minutes of CPR should a baby be delivered, do you need to go to theatre?
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
Can CPR continue whilst you deliver the baby at 4 min
Yes
What medication do you give in cardiac arrest
1 mg Adrenaline every 2 min
What medication do you give for VF/VT
300mg amiodarone
What are the shockable rhythms
VF and pulseless VT
What are the NON shockable rhythms
PEA and asystole
What medication is given in opioid overdose
0.4-0.8mg naloxone
What medication is given for magnesium sulphate overdose
1g Calcium gluconate
What medication is given for local anaesthetic overdose
1.5ml 20% Intralipid
How do you manage an eclamptic seizure
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
What is happening after 5 minutes of seizure
status epilepticus
Management of anaphylaxis
remove allergen high flow O2 IM adernaline every 5 minutes IV crystalloid bolus IV chlopheniramine IV hydrocortisone Neb salbutamol
Pregnant women may be normoglycaemic in DKA, true or false
TRUE
Signs + Management of amniotic fluid embolism
supportive and intensive care foetal distress resp distress DIC seizure Increased Zn coproporphyrin levels Clinical diagnosis largely
Can you thrombolyse a pregnant women with a massive PE
Yes with heparin
how severe is cord prolapse
obstetric emergency
causes direct compression and cord spasm - hypoxia and death
Features of cord prolapse
malpresentation pre term ruptured membranes 2nd twin may or may not see cord come down
How soon should a baby be delivered if there is cord prolapse
ASAP - category 1 c-section
What should always be done before artificial rupture of membranes ARM
Palpate the abdomen to ensure the head is engaged and avoid a cord prolapse
Shoulder dystocia is an obstetric emergency, true or false
TRUE
What is the management of shoulder dystocia
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
What are the 5 H’s that cause maternal collapse
Head Heart Hypoxia Haemorrhage wHole body and Hazards
Head: causes of collapse
eclampsia
epilepsy
cerebrovascular incident
vasovagal response
Heart: causes of collapse
MI
arrythmias
peripartum cardiomyopathy
Hypoxia: causes of collapse
asthma
PE
pulmonary oedema
anaphylaxis
Haemorrhage: causes of collapse
uterine rupture placental abruption atony trauma ruptured aneurysm
wHole body and Hazards: causes of collapse
hypoglycaemia amniotic fluid embolism sepsis trauma anaesthetic complications drug overdose
why is it harder to resuscitate a pregnant woman
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
As soon as infant is delivered, vena cava returns to normal and cardiac output is restored
True or false
TRUE
How do you do MUD
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
What should be ensured when an AED indicates shock
ensure no one is touching the patient
ensure oxygen mask is far away
When do you give adrenaline in cardiac arrest with shockable rhythms
1mg adrenaline should be given after the 3rd shock with defibrillator and then every other cycle (every 4 minutes)
When should amiodarone be given in cardiac arrest with shockable rhythms
after the 3rd shock with the defibrillator
When should adrenaline be given in non-shockable rhythms
every 3-5 minutes
Signs of massive PE in a pregnant woman
raised JVP enlarged liver parasternal heave fixed splitting of 2nd heart sound \+- evidence of DVT
What is shoulder dystocia
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
What signs can be seen in shoulder dystocia
head bobbing
turtle sign
in which position should pregnant women be assessed
left lateral position
what systems can you use in the assessment of maternal collapse
ABCDE
primary obstetric survey / PROMPT - starts at the head and works downwards
describe the PROMPT assessment
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
what interventions can you make if the cause of maternal collapse is not obvious
fluid resuscitation
? laparotomy
Sepsis 6?
intensive care?
contraindications to fluid resuscitation
pulmonary oedema as a result of severe pre-eclampsia or renal failure
what is the secondary survey
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
causes of maternal collapse 5H’s
Head Heart Hypoxia Haemorrhage wHole body and Hazards
potential causes of maternal collapse: HEAD
eclampsia epilepsy CVA intracranial haemorrhage vasovagal response
potential causes of maternal collapse: HEART
MI arrythmias peripartum cardiomyopathy congenital heart disease thoracic aortic dissection cardiac arrest
potential causes of maternal collapse: HYPOXIA
asthma
PE
pulmonary oedema
anaphylaxis
potential causes of maternal collapse: HAEMORRHAGE
placental abruption uterine atony genital tract trauma uterine rupture uterine inversion ruptured aneurysm
potential causes of maternal collapse: wHole body and Hazards
hypoglycaemia amniotic fluid embolus sepsis trauma complications of anaesthesia anaphylaxis
management of uterine atony as a cause of PPH
expel clots and massage uterus
IV access + bloods: FBC, coagulation, cross match
IV fluids
uterotonics - syntocin/ergometrine/carboprost
tranexamic acid
urinary catheter
