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Reproductive & Sexual Health > Maternal Collapse > Flashcards

Maternal Collapse Flashcards

1
Q

What are the leading causes of maternal death up to six weeks after the end of pregnancy?

A

Thromboembolism and cardiac disease

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2
Q

What are the leading causes of maternal death from six weeks up to a year after the end of pregnancy?

A

Cancer and suicide

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3
Q

What score required prompt medical review on MOEWC?

A

1 red or 2 amber

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4
Q

What is maternal collapse?

A

Respiratory or cardiac distress that may lead to cardiac arrest

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5
Q

What are the 5H’s of maternal collapse?

A
  • Head- eclampsia, epilepsy, cerebrovascular accident, vasovagal response
  • Heart- MI, arrythmias, peripartum cardiomyopathy
  • Hypoxia- asthma, PE, pulmonary oedema, anaphylaxis
  • Haemorrhage- abruption, atony, trauma, uterine rupture, uterine inversion, ruptured aneurysm
  • wHole body and hazards- hypoglycaemia, amniotic fluid embolism, septicaemia, trauma, anaesthetic complications, drug overdose
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6
Q

Why does gravid uterus complicate resuscitation?

A

It causes aortocaval compression which reduces venous return to the heart- cardiac compressions will be less effective at creating a circulation

Ventilation is more difficult due to the pressure on the diaphragm from the uterus

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7
Q

How does the fetus/placenta make resuscitation more difficult?

A
  • The feto-placental unit effectively ‘steals’ oxygen and circulating volume from the mother – reducing the effectiveness of CPR.
  • 20% reduction in pulmonary function residual capacity and 20% increase in oxygen consumption- greater risk of hypoxia
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8
Q

Why are pregnant women more difficult to intubate?

A

oedema and the larger tongue and breasts of pregnancy

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9
Q

Why are pregnant women more likely to aspirate?

A

Hormonal relaxation of the oesophageal sphincter and delayed gastric emptying

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10
Q

How can supine hypotension be reversed?

A

Roll the women into left lateral position

Manual uterine displacement

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11
Q

What should happen if there is no response to CPR performed within 4 minutes of maternal collapse?

A

Delivery should be undertaken to assist maternal resuscitation

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12
Q

Describe the process of peri-mortem CS?

A
  • limited equipment needed
  • sterile preparation and drapes
  • moving to theatre not necessary
  • CPR should continue throughout
  • diathermy will not be needed as there is little blood loss if there is no CO
  • if mum successful resuscitated she can be moved to theatre to complete operaton
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13
Q

What are the 4H’s and 4T’s

A

Reversible causes of cardiac arrest

Hypoxia

Hyopovolaemia

Hypo/hypermetabolic

Hypothermia

Thrombosis

Tamponade

Toxins

Tension pneumothorax

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14
Q

What is the specific drug treatment for cardiac arrest?

A

1 mg adrenaline (epinephrine) every 2 minutes

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15
Q

What is the specific drug treatment for VF/VT?

A

300mg amiodarone

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16
Q

What is the specific drug treatment for opiate overdose?

A

0.4-0.8mg naloxone

17
Q

What is the specific drug treatment for magnesium toxicity?

A

1 g calcium gluconate (10ml 10% calcium gluconate)

18
Q

What is the specific drug treatment for local anaesthetic toxicity?

A

1.5ml 20% intralipid

19
Q

What is the management of eclampsia/seizure?

A
  • žCall for help
  • žMake patient safe
  • žNote time and length of seizure
  • žGive high flow oxygen
  • žDon’t restrain patient during fit
  • žGet IV access
  • žMove patient into left lateral and open airway
  • žMonitor baby
20
Q

What is the management of anaphylaxis?

A
  • žRemove allergen
  • žHigh flow oxygen
  • žIM adrenaline 500mcg every 5 mins and IV Crystalloid bolus
  • žChlorpheniramine 20mg IV
  • žHydrocortisone 200mg IV
  • žSalbutamol neb
21
Q

What is the management of glucose <3mmol/l?

A

ž50ml of 10% dextrose Ivor 1mg glucagon IM or glucogel (stop insulin!)

22
Q

What is the DKA diagnostic criteria?

A
  • Ketonaemia 3mmol/l and over or significant ketonuria
  • blood glucose over 11mmol/l or known diabetes mellitus
  • venous bicarbonate (HCO3) below 15mmol/l or venous pH < 7.3
23
Q

What happens in amniotic fluid embolism?

A

Amniotic fluid enters maternal circulation- collape +/- arrest

Acute presentation: profound fetal distress, sudden resp distress, seizure and DIC

24
Q

How is amniotic fluid embolism confirmed on postmortem?

A

By squames on right sided circulation

25
Q

Describe the presentation of massive PE?

A

Cyanosis

Shock

Collapse

Tacypnoea, dyspnoea, pain, apprehension, cough, haemoptysis, temp >37

26
Q

Describe investigation if suspected PE?

A
  • ECG- tachycardia and right sided strain
  • CXR- exclude pneumothorax and pneumonia- may see pleural effusion, raised hemidiaphragm and wedge collapse.
  • ABG- may show hypoxia and a normal or low CO2
  • Echo- rule out dissection and tamponade
  • Consider pulmonary angiography
  • consider CTPA
27
Q

How should PE be managed?

A

Therapeutic Tx with heparin

Thrombolysis

28
Q

How does CVA present?

A

Headache, vomiting, hypertension, seizure, collapse

Can have focal signs- neck stiffness, papilloedema

29
Q

How should suspected CVA be investigated?

A
  • Head CT/MRI
  • Echo, coagulation screen, thrombophilia screen, carotid doppler, lumbar puncture, cerebral angiography
30
Q

What is cord prolapse associated with?

A

malpresentation, preterm labour, 2nd twin, artificial membrane rupture

31
Q

What are the complications of cord prolapse?

A

Direct compression and cord spasm = decreased flow = hypoxia = death

32
Q

How should cord prolapse be investigated?

A

Scan for fetal cardiac activity

33
Q

How should cord prolapse be treated?

A

Immediate delivery - Cat 1 (Cs or forceps)

Tocolytic (reduce contractions) and maternal positions to relieve pressure

(cont ve/knee- chest position)

34
Q

What is shoulder dystocia?

A

Any cephalic delivery where manoeuvres other than gentle traction are required to deliver the baby and after the head has delivered (1%)

Bony impaction of foetal anterior shoulder on the maternal symphysis

35
Q

what are the risk factors for shoulder dystocia?

A

Obesity

Diabetes

Macrosomia

Prolonged 1st and 2nd stage

Instrumental delivery

36
Q

What are the signs of shoulder dystocia?

A

Slow delivery of the head, face and chin

Turtling of the head against perineum

Lack of restitution

37
Q

What is head bobbing

A

When the head consistently retracts back between contractions during the active second stage

38
Q

What is turtle sign

A

When the delivered head becomes tightly pulled back against the perineum and there is diffficulty delivering the chin

39
Q

What is the management of shoulder dystocia?

A
  • Help
  • Evaluate for episiotomy
  • Legs (McRoberts manouevre)
  • Pressure (suprapubic)
  • Enter (rotational maneouvre)
  • Remove the posterior arm
  • Roll the patient onto her hands and knees

Reproductive & Sexual Health (54 decks)

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