Maternal Collapse Flashcards
What is a common factor in most women who die during childbirth/pregnancy?
Most had underlying health problems or other risk factors
What groups are at risk of maternal death?
Black and Asian women, older women, women from deprived areas
What are the leading causes of maternal death up to 6 weeks after end of pregnancy?
Thromboembolism and cardiac disease
What are the leading causes of maternal death from 6 weeks up to 1 year after pregnancy?
Cancer and suicide
What are the principles of management for an obstetric emergency?
Anticipation and preparation are key
Two lives are at risk but prioritise mother
Get help early = maternity emergency bleep or maternity cardiac arrest bleep
What is the maternal Obstetric Early Warning chart?
Like a NEWS chart but with urine passage and proteinuria categories = red or amber needs review
What can respiratory or cardiac distress lead to?
Cardiac arrest
What are the 5H’s of maternal collapse?
Head, hypoxia, heart, haemorrhage, hazards and whole body
What are some head and heart pathologies that may cause maternal collapse?
Head = eclampsia, epilepsy, cerebrovascular accident, vasovagal response Heart = MI, arrhythmias, peripartum cardiomyopathy
What are some causes of hypoxia and haemorrhage which may lead to maternal collapse?
Hypoxia = asthma, PE, pulmonary oedema, anaphylaxis Haemorrhage = abruption, atony, trauma, uterine rupture, uterine invasion, ruptures aneurysm
What are some hazards and whole body causes of maternal collapse?
Hypoglycaemia, amniotic fluid embolism, trauma, septicaemia, drug overdose, anaesthetic complications
How do you assess whether an airway is patent?
Awake = ability to speak, noisy breathing, foreign body Unconscious = head tilt-chin lift, look and listen for breathing
How do you assess breathing?
Respiratory rate, added sounds, patient position and use of accessory muscles, chest examination
What actions can be taken if you encounter a problem when assessing breathing?
Administer oxygen if hypoxic
Non-rebreathe mask will deliver 65-85% oxygen
How do you assess circulation?
Pulse rate and volume, BP, capillary refill, skin temperature, urine output
What actions can be taken if a problem is found when assessing circulation?
Gain venous access, take appropriate bloods, consider rapid fluid bolus
How is disability assessed and managed?
Assessment = AVPU, pupil reactivity/size, glucose level Action = nurse unconscious patients in left lateral position, give glucose if blood glucose <4
How is exposure assessed?
Top to toe examination = temperature, rashes, injury, bleeding, signs of infection
Why are pregnant women more difficult to resuscitate?
Gravid uterus, presence of foetus and placenta, more likely to aspirate, more difficult to intubate
How does pregnancy impact lung function?
20% decrease in pulmonary functional capacity and 20% increase in oxygen consumption = makes resuscitation more difficult
Why does a gravid uterus make resuscitation more difficult?
Causes aortocaval compression
Ventilation difficult due to pressure on diaphragm
Why do the foetus and placenta make resuscitation more difficult?
Steal oxygen and circulation from mother
What stage of pregnancy does aortocaval compression begin at?
From 20 weeks gestation = compression of IVC and aorta in supine position, reduces venous return, returns to normal after delivery
How does aortocaval compression cause supine hypotension?
Reduces cardiac output by up to 40%
What can supine hypotension lead to?
Maternal collapse = can be reversed by turning woman into left lateral position
What position should women be kept in during CPR?
Supine with left uterine displacement = manually displace uterus or use 30 degree tilt if on table