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reproduction & sexual health > Maternal Collapse and Emergencies > Flashcards

Maternal Collapse and Emergencies Flashcards

1
Q

What are the most common causes of maternal death <6 weeks postpartum?

A

Thromboembolic disease

Cardiac disease

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2
Q

What are the most common causes of maternal death >6 weeks postpartum?

A

Cancer

Suicide

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3
Q

Name the five H’s - causes of maternal collapse

A 
Head - eclampsia, CVA
Heart 
Hypoxia 
Haemorrhage 
wHole body
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4
Q

What are the 4H’s and 4T’s of cardiac arrest?

A

Hypoxia
Hypovolaemia
Hypo/hypermetabolic
Hypothermia

Thrombo-embolism
Toxins
Tamponade
Tension pneumothorax

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5
Q

What are the additional two C’s of cardiac arrest in pregnancy?

A

Eclampsia

Intracerebral bleed

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6
Q

What makes resuscitation in a pregnant woman more difficult?

A

Gravid Uterus

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7
Q

Describe what is meant by the term gravid uterus

A

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

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8
Q

How is supine hypotension reversed?

A

Turn the woman to the left lateral position

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9
Q

Why do pregnant women have an increased risk of aspiration?

A

Progesterone relaxes ligaments/muscles including the oesophageal sphincter causing delayed gastric emptying and intubation difficulties
Breast tissue and oedema also make it harder

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10
Q

If a pregnant woman collapses what must someone do?

A

Manual Uterine Displacement

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11
Q

What should be done if there is no response to CPR within 4 minutes?

A

Perimortem C-section

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12
Q

Describe a perimortem C-section

A

Little blood loss due to no cardiac output

CPR continues throughout and if successful mother is moved to theatre to complete operation

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13
Q

What drug treatment can be given after shocks?

A

Amiodarone - after 3rd shock

Adrenaline - after 3rd shock and every other cycle

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14
Q

What drug treatment can be given in non-shockable rhythm?

A

Adrenaline every 3-5 minutes

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15
Q

What drug can treat opiate overdose?

A

Naloxone

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16
Q

How is magnesium toxicity treated?

A

Calcium glutonate

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17
Q

How is anaesthetic toxicity treated?

A

Intralipid

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18
Q

Describe the treatment of Anaphylactic shock in pregnant women

A 
High flow oxygen 
IM adrenaline and crystalloid IV bolus 
Chlorpheniramine 
Hydrocortisone 
Salbutamol
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19
Q

What are the three criteria for diagnosis of DKA?

A
  • ketonaemia
  • blood glucose
  • venous bicarbonate <15 or pH <7.3
20
Q

If a woman is hypoglycaemic what should be done?

A

50ml 10% dextrose IV
1mg glucagon IM or glycogen
Stop insulin

21
Q

How is DKA treated?

A

Fluid replacement
Insulin therapy
ABG
Monitor baby

22
Q

What is the percentage mortality in amniotic fluid embolism?

A

30%

23
Q

Describe amniotic fluid embolism

A

Amniotic fluid enters maternal circulation usually in labour causing collapse and arrest

24
Q

How does amniotic fluid embolism present?

A

Profound fetal distress, sudden respiratory distress, seizure, DIC

25
Q

How is amniotic fluid embolism treated?

A

ICU treatment

26
Q

What will be identified in a post mortem of a woman who has died from amniotic fluid embolism?

A

Squames on right sided circulation

27
Q

When is a woman at highest risk of PE?

A

Postnatally

28
Q

How does a PE in pregnancy present?

A

Cyanosis, collapse, shock, raised JVP, large liver, parasternal heave, haemoptysis

29
Q

What investigations are done in suspected PE?

A

ECG
CXR
ABG
consider CTPA and pulmonary angiogram

30
Q

How is a PE treated?

A

Heparin

31
Q

How do cerebrovascular accidents present in pregnant women?

A

Headache, vomiting, hypertension, seizure, collapse, may have focal signs

32
Q

How is CVA investigated?

A

CT/MRI head

Echo, coagulation screen, carotid doppler, LP, cerebral angiogram

33
Q

When does cord prolapse occur?

A

When the amniotic sac ruptures or is artificially ruptured

34
Q

What are the signs of cord prolapse?

A

Fetal heart becomes dramatically bradycardia, associated with malpresentation, preterm labour, 2nd tiwn

35
Q

How is cord prolapse managed in hospital?

A

C-section under GA

Forceps if cervix dilated

36
Q

What is the management if cord prolapse is detected in the community?

A

Tocolytic and maternal positions, relieve pressure for transfer - push foetus up by vaginal examination to prevent complete occlusion

37
Q

What is shoulder dystocia?

A

Cephalic delivery where manoeuvres other than gentle traction are required after delivery of the head - bony impaction of the anterior shoulder on maternal symphysis

38
Q

What are the risk factors for shoulder dystocia?

A

Obesity, diabetes, macrosomia, prolonged 1st and 2nd stage, instrumental delivery

39
Q

What are the signs of shoulder dystocia?

A

Slow delivery of the head, face and chin, lack of restitution
‘turtling’ and ‘head bobbing’

40
Q

What is meant by turtling?

A

Head becomes tightly pulled back against the perineum and difficulty delivering the chin

41
Q

What is meant by head bobbing?

A

Head consistently retracts back between contraction during active second stage

42
Q

What are the complications of shoulder dystocia?

A

Stillbirth, hypoxic brain injury, brachial plexus injury, fractures, PPH, 3rd and 4th degree distress

43
Q

How quickly should the baby be delivered in shoulder dystocia to prevent hypoxia?

A

Within 5 minutes of the head being delivered

44
Q

How is shoulder dystocia managed?

A

Evaluate for episiotomy
McRobert’s manoeuvre
Suprapubic pressure on the posterior aspect of the anterior fetal shoulder

45
Q

What is the aim of the manoeuvres?

A

Increase size of pelvis
Narrow bisacromial diameter of foetus
Change position of bisacromiall diameter

reproduction & sexual health (36 decks)

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