Maternal Collapse Flashcards
What are the leading causes of maternal death up to six weeks after the end of pregnancy?
Thromboembolism and cardiac disease
What are the leading causes of maternal death from six weeks up to a year after the end of pregnancy?
Cancer and suicide
What score required prompt medical review on MOEWC?
1 red or 2 amber
What is maternal collapse?
Respiratory or cardiac distress that may lead to cardiac arrest
What are the 5H’s of maternal collapse?
- 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
Why does gravid uterus complicate resuscitation?
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
How does the fetus/placenta make resuscitation more difficult?
- 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
Why are pregnant women more difficult to intubate?
oedema and the larger tongue and breasts of pregnancy
Why are pregnant women more likely to aspirate?
Hormonal relaxation of the oesophageal sphincter and delayed gastric emptying
How can supine hypotension be reversed?
Roll the women into left lateral position
Manual uterine displacement
What should happen if there is no response to CPR performed within 4 minutes of maternal collapse?
Delivery should be undertaken to assist maternal resuscitation
Describe the process of peri-mortem CS?
- 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
What are the 4H’s and 4T’s
Reversible causes of cardiac arrest
Hypoxia
Hyopovolaemia
Hypo/hypermetabolic
Hypothermia
Thrombosis
Tamponade
Toxins
Tension pneumothorax
What is the specific drug treatment for cardiac arrest?
1 mg adrenaline (epinephrine) every 2 minutes
What is the specific drug treatment for VF/VT?
300mg amiodarone
What is the specific drug treatment for opiate overdose?
0.4-0.8mg naloxone
What is the specific drug treatment for magnesium toxicity?
1 g calcium gluconate (10ml 10% calcium gluconate)
What is the specific drug treatment for local anaesthetic toxicity?
1.5ml 20% intralipid
What is the management of eclampsia/seizure?
- Call for help
- Make patient safe
- Note time and length of seizure
- Give high flow oxygen
- Don’t restrain patient during fit
- Get IV access
- Move patient into left lateral and open airway
- Monitor baby
What is the management of anaphylaxis?
- Remove allergen
- High flow oxygen
- IM adrenaline 500mcg every 5 mins and IV Crystalloid bolus
- Chlorpheniramine 20mg IV
- Hydrocortisone 200mg IV
- Salbutamol neb
What is the management of glucose <3mmol/l?
50ml of 10% dextrose Ivor 1mg glucagon IM or glucogel (stop insulin!)
What is the DKA diagnostic criteria?
- 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
What happens in amniotic fluid embolism?
Amniotic fluid enters maternal circulation- collape +/- arrest
Acute presentation: profound fetal distress, sudden resp distress, seizure and DIC
How is amniotic fluid embolism confirmed on postmortem?
By squames on right sided circulation
Describe the presentation of massive PE?
Cyanosis
Shock
Collapse
Tacypnoea, dyspnoea, pain, apprehension, cough, haemoptysis, temp >37
Describe investigation if suspected PE?
- 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
How should PE be managed?
Therapeutic Tx with heparin
Thrombolysis
How does CVA present?
Headache, vomiting, hypertension, seizure, collapse
Can have focal signs- neck stiffness, papilloedema
How should suspected CVA be investigated?
- Head CT/MRI
- Echo, coagulation screen, thrombophilia screen, carotid doppler, lumbar puncture, cerebral angiography
What is cord prolapse associated with?
malpresentation, preterm labour, 2nd twin, artificial membrane rupture
What are the complications of cord prolapse?
Direct compression and cord spasm = decreased flow = hypoxia = death
How should cord prolapse be investigated?
Scan for fetal cardiac activity
How should cord prolapse be treated?
Immediate delivery - Cat 1 (Cs or forceps)
Tocolytic (reduce contractions) and maternal positions to relieve pressure
(cont ve/knee- chest position)
What is shoulder dystocia?
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
what are the risk factors for shoulder dystocia?
Obesity
Diabetes
Macrosomia
Prolonged 1st and 2nd stage
Instrumental delivery
What are the signs of shoulder dystocia?
Slow delivery of the head, face and chin
Turtling of the head against perineum
Lack of restitution
What is head bobbing
When the head consistently retracts back between contractions during the active second stage
What is turtle sign
When the delivered head becomes tightly pulled back against the perineum and there is diffficulty delivering the chin
What is the management of shoulder dystocia?
- Help
- Evaluate for episiotomy
- Legs (McRoberts manouevre)
- Pressure (suprapubic)
- Enter (rotational maneouvre)
- Remove the posterior arm
- Roll the patient onto her hands and knees
