Maternal Collapse and Emergencies Flashcards
What are the most common causes of maternal death <6 weeks postpartum?
Thromboembolic disease
Cardiac disease
What are the most common causes of maternal death >6 weeks postpartum?
Cancer
Suicide
Name the five H’s - causes of maternal collapse
Head - eclampsia, CVA Heart Hypoxia Haemorrhage wHole body
What are the 4H’s and 4T’s of cardiac arrest?
Hypoxia
Hypovolaemia
Hypo/hypermetabolic
Hypothermia
Thrombo-embolism
Toxins
Tamponade
Tension pneumothorax
What are the additional two C’s of cardiac arrest in pregnancy?
Eclampsia
Intracerebral bleed
What makes resuscitation in a pregnant woman more difficult?
Gravid Uterus
Describe what is meant by the term gravid uterus
From 20 weeks in the supine position the uterus can compress the venous return to the heart and put pressure on the diaphragm making compressions and ventilation more difficult
How is supine hypotension reversed?
Turn the woman to the left lateral position
Why do pregnant women have an increased risk of aspiration?
Progesterone relaxes ligaments/muscles including the oesophageal sphincter causing delayed gastric emptying and intubation difficulties
Breast tissue and oedema also make it harder
If a pregnant woman collapses what must someone do?
Manual Uterine Displacement
What should be done if there is no response to CPR within 4 minutes?
Perimortem C-section
Describe a perimortem C-section
Little blood loss due to no cardiac output
CPR continues throughout and if successful mother is moved to theatre to complete operation
What drug treatment can be given after shocks?
Amiodarone - after 3rd shock
Adrenaline - after 3rd shock and every other cycle
What drug treatment can be given in non-shockable rhythm?
Adrenaline every 3-5 minutes
What drug can treat opiate overdose?
Naloxone
How is magnesium toxicity treated?
Calcium glutonate
How is anaesthetic toxicity treated?
Intralipid
Describe the treatment of Anaphylactic shock in pregnant women
High flow oxygen IM adrenaline and crystalloid IV bolus Chlorpheniramine Hydrocortisone Salbutamol
What are the three criteria for diagnosis of DKA?
- ketonaemia
- blood glucose
- venous bicarbonate <15 or pH <7.3
If a woman is hypoglycaemic what should be done?
50ml 10% dextrose IV
1mg glucagon IM or glycogen
Stop insulin
How is DKA treated?
Fluid replacement
Insulin therapy
ABG
Monitor baby
What is the percentage mortality in amniotic fluid embolism?
30%
Describe amniotic fluid embolism
Amniotic fluid enters maternal circulation usually in labour causing collapse and arrest
How does amniotic fluid embolism present?
Profound fetal distress, sudden respiratory distress, seizure, DIC
How is amniotic fluid embolism treated?
ICU treatment
What will be identified in a post mortem of a woman who has died from amniotic fluid embolism?
Squames on right sided circulation
When is a woman at highest risk of PE?
Postnatally
How does a PE in pregnancy present?
Cyanosis, collapse, shock, raised JVP, large liver, parasternal heave, haemoptysis
What investigations are done in suspected PE?
ECG
CXR
ABG
consider CTPA and pulmonary angiogram
How is a PE treated?
Heparin
How do cerebrovascular accidents present in pregnant women?
Headache, vomiting, hypertension, seizure, collapse, may have focal signs
How is CVA investigated?
CT/MRI head
Echo, coagulation screen, carotid doppler, LP, cerebral angiogram
When does cord prolapse occur?
When the amniotic sac ruptures or is artificially ruptured
What are the signs of cord prolapse?
Fetal heart becomes dramatically bradycardia, associated with malpresentation, preterm labour, 2nd tiwn
How is cord prolapse managed in hospital?
C-section under GA
Forceps if cervix dilated
What is the management if cord prolapse is detected in the community?
Tocolytic and maternal positions, relieve pressure for transfer - push foetus up by vaginal examination to prevent complete occlusion
What is shoulder dystocia?
Cephalic delivery where manoeuvres other than gentle traction are required after delivery of the head - bony impaction of the anterior shoulder on 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, lack of restitution
‘turtling’ and ‘head bobbing’
What is meant by turtling?
Head becomes tightly pulled back against the perineum and difficulty delivering the chin
What is meant by head bobbing?
Head consistently retracts back between contraction during active second stage
What are the complications of shoulder dystocia?
Stillbirth, hypoxic brain injury, brachial plexus injury, fractures, PPH, 3rd and 4th degree distress
How quickly should the baby be delivered in shoulder dystocia to prevent hypoxia?
Within 5 minutes of the head being delivered
How is shoulder dystocia managed?
Evaluate for episiotomy
McRobert’s manoeuvre
Suprapubic pressure on the posterior aspect of the anterior fetal shoulder
What is the aim of the manoeuvres?
Increase size of pelvis
Narrow bisacromial diameter of foetus
Change position of bisacromiall diameter
