Maternal Collapse Flashcards
What can happen to any pregnant woman who is on their back? What should you do to prevent this?
vasovagal
turn them onto their side!
What are the 5 common causes of respiratory or cardiac collapse?
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
What is a Gravid Uterus?
pregnant uterus that is entrapped between the sacral promontory and pubic symphysis
What does a Gravid Uterus cause?
aortocaval compression
ventilation is difficult due to pressure on the diaphragm
How does the ABCDE approach apply to pregnant women?
from 10 weeks gestation - do not lie supine
MOTHER COMES FIRST
use manual uterine displacement - push bump the LHS
After 4 minutes of CPR on a mother - what must happen?
deliver the baby by minute 5
What drug should be given for a cardiac arrest in a pregnant woman?
1mg adrenaline
What drug should be given for VF/VT in a pregnant woman?
300mg amiodarone
What drug should be given for an opiate overdose in a pregnant woman?
0.4-0.8 naloxone
What drug should be given for magnesium toxicity in a pregnant woman?
1g calcium gluconate
What drug should be given for a local anaesthetic toxicity in a pregnant woman?
1.5ml 20% intralipid
How do you approach anaphylaxis in a pregnant woman?
remove allergen high flow O2 IM adrenaline 500mcg every 5mins and IV crystalloid bolus chlorpheniramine 20mg IV hydrocortisone 200mg IV salbutamol nebs
What is the mortality of amniotic fluid embolisms?
30%
What is an amniotic fluid embolism?
amniotic fluid enters the maternal circulation causing collapse/arrest
happens during labour
How do amniotic fluid embolisms present?
profound foetal distress
sudden resp distress
seizure
disseminated intravascular coagulation
How are amniotic fluid embolisms treated?
supportive in ITU
How are amniotic fluid embolisms diagnosed?
zinc cophoporphyrin levels sometimes increased
post mortem = squames on right side of circulation
How does a cord prolapse happen?
due to mal presentation
preterm labour
2nd twin
artifical membrane rupture
What happens during a cord prolapse?
direct compression and cord spasm leads to decreased flow -> hypoxia->death
What is scanned for in a cord prolapse?
fetal cardiac activity
How is a cord prolapse treated?
catagory 1 c/section or forceps delivery
toxolytic and knee to chest maternal position to relieve pressure
What is shoulder dystocia?
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
What can cause shoulder dystocia?
obesity diabetes macrosomia prolonged 1st and 2nd stage instrumental delivery
What are the signs of shoulder dystocia?
slow deliery of the head, face and chin
turning of the head against the perineum
head bobbing - head retracts after each contraction
What are the complications of shoulder dystocia?
still birth hypoxic brain injury brachial plexus injury fractures PPH 3rd and 4th degree distress
How do you reduce the risk of shoulder dystocia?
deliver baby within 5 mins from the delivery of the head
