Maternal Collapse

Question 1

What can happen to any pregnant woman who is on their back? What should you do to prevent this?

Answer 1

vasovagal

turn them onto their side!

Question 2

What are the 5 common causes of respiratory or cardiac collapse?

Answer 2

5 Hs!
Head - ecclampsia, epilepsy, CV accident, vasovagal response
Heart - MI, arrythmia, peripartum cardiomyopathy
Haemorrhage - abruption, uterine atony, trauma, uterine rupture, uterine invasion, ruptured aneurysm
Hypoxia - asthma, PE, pulmonary oedema, anapylaxis
wHole body + Hazards - hypoglycaemia, amniotic fluid embolism, speticaemia, trauma, drug overdose

Question 3

What is a Gravid Uterus?

Answer 3

pregnant uterus that is entrapped between the sacral promontory and pubic symphysis

Question 4

What does a Gravid Uterus cause?

Answer 4

aortocaval compression

ventilation is difficult due to pressure on the diaphragm

Question 5

How does the ABCDE approach apply to pregnant women?

Answer 5

from 10 weeks gestation - do not lie supine
MOTHER COMES FIRST
use manual uterine displacement - push bump the LHS

Question 6

After 4 minutes of CPR on a mother - what must happen?

Answer 6

deliver the baby by minute 5

Question 7

What drug should be given for a cardiac arrest in a pregnant woman?

Answer 7

1mg adrenaline

Question 8

What drug should be given for VF/VT in a pregnant woman?

Answer 8

300mg amiodarone

Question 9

What drug should be given for an opiate overdose in a pregnant woman?

Answer 9

0.4-0.8 naloxone

Question 10

What drug should be given for magnesium toxicity in a pregnant woman?

Answer 10

1g calcium gluconate

Question 11

What drug should be given for a local anaesthetic toxicity in a pregnant woman?

Answer 11

1.5ml 20% intralipid

Question 12

How do you approach anaphylaxis in a pregnant woman?

Answer 12

remove allergen
high flow O2
IM adrenaline 500mcg every 5mins and IV crystalloid bolus
chlorpheniramine 20mg IV
hydrocortisone 200mg IV
salbutamol nebs

Question 13

What is the mortality of amniotic fluid embolisms?

Answer 13

30%

Question 14

What is an amniotic fluid embolism?

Answer 14

amniotic fluid enters the maternal circulation causing collapse/arrest
happens during labour

Question 15

How do amniotic fluid embolisms present?

Answer 15

profound foetal distress
sudden resp distress
seizure
disseminated intravascular coagulation

Question 16

How are amniotic fluid embolisms treated?

Answer 16

supportive in ITU

Question 17

How are amniotic fluid embolisms diagnosed?

Answer 17

zinc cophoporphyrin levels sometimes increased

post mortem = squames on right side of circulation

Question 18

How does a cord prolapse happen?

Answer 18

due to mal presentation
preterm labour
2nd twin
artifical membrane rupture

Question 19

What happens during a cord prolapse?

Answer 19

direct compression and cord spasm leads to decreased flow -> hypoxia->death

Question 20

What is scanned for in a cord prolapse?

Answer 20

fetal cardiac activity

Question 21

How is a cord prolapse treated?

Answer 21

catagory 1 c/section or forceps delivery

toxolytic and knee to chest maternal position to relieve pressure

Question 22

What is shoulder dystocia?

Answer 22

any cephalic delivery where manouvres other than gentle traction are required to deliver the baby
bony impaction of the anterior shoulder on the pubic symphysis

Question 23

What can cause shoulder dystocia?

Answer 23

obesity
diabetes
macrosomia
prolonged 1st and 2nd stage
instrumental delivery

Question 24

What are the signs of shoulder dystocia?

Answer 24

slow deliery of the head, face and chin
turning of the head against the perineum
head bobbing - head retracts after each contraction

Question 25

What are the complications of shoulder dystocia?

Answer 25

still birth
hypoxic brain injury
brachial plexus injury
fractures
PPH
3rd and 4th degree distress

Question 26

How do you reduce the risk of shoulder dystocia?

Answer 26

deliver baby within 5 mins from the delivery of the head