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Repro and Sexual Health > Maternal Collapse and Obstetric Emergencies > Flashcards

Maternal Collapse and Obstetric Emergencies Flashcards

1
Q

In developed countries, what is the maternal death rate?

A

10 per 100,000

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2
Q

In developing countries, what is the maternal death rate and what are the causes?

A 
462 per 100,000
PPH
Infections
Labour complications 
Unsafe abortion
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3
Q

What is MBRACE?

A

Examines all UK maternal deaths within a year of delivery

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4
Q

What are the commonest causes of maternal death in the UK?

A 
Cardiac disease
Thrombosis and VTE
Neurological
Psychiatric
Sepsis
Haemorrhage 
Amniotic fluid embolism
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5
Q

What are the 5Hs of maternal collapse?

A

Head; eclampsia, epilepsy, CVA, vasovagal
Heart; MI, arrhythmia, peripartum cardiomyopathy
Hypoxia; asthma, PE, pulmonary oedema, anaphylaxis
Haemorrhage; abruption, atony, uterine rupture, uterine inversion, ruptured aneurysm
wHole body and Hazards: hypoglycaemia, amniotic fluid embolism, sepsis, trauma, anaesthetic cx, drug overdose

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6
Q

Why is resuscitating a pregnant woman difficulty?

A

Gravid uterus; aortocaval compression, ventilation difficult due to pressure on diaphragm
Fetus steals oxygen (reduces pulmonary function by 20%, 20% decrease in oxygen consumption)
More likely to aspirate
More difficult to intubate

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7
Q

When will aortocaval compression begin?

A

From 20 weeks gestation, in supine position the gravid uterus can compress IVC and aorta reducing venous return

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8
Q

What is a very important manoeuvre whilst resuscitating a pregnant woman?

A

Manual uterine displacement

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9
Q

In what position should a collapsed pregnant woman be put in?

A

Left lateral

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10
Q

In non-pregnant woman what percentage of normal cardiac output will chest compressions achieve?

A

30%

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11
Q

In pregnant woman, what percentage of normal cardiac output will chest compressions achieve?

A

Aortocaval compression reduces CO to around 10%

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12
Q

When should a perimortem c-section be performed in pregnant women who are in cardiac arrest?

A

If no response to correctly performed CRP within 4 mins of maternal collapse, delivery should be undertaken

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13
Q

What are shockable rhythms?

A

VF

Pulseless VT

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14
Q

When should adrenaline and amiodarone be given in cardiac arrest?

A

Adrenaline after 3rd shock then every other cycle

Amiodarone 300mg given after 3rd shock

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15
Q

How is tube placement in intubation confirmed?

A

Capnography

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16
Q

What are the 4Hs and 4Ts of cardiac arrest?

A 
Hypoxia
Hypovolemia
Hypo/hyper metabolic
Hypothermia
Thrombosis
Tamponade
Toxins
Tension pneumo
In pregnant woman; add PET
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17
Q

What drug should be considered in opiate overdose?

A

0.4-0.8 mg naloxone

18
Q

What drug should be considered in magnesium toxicity?

A

1g calcium gluconate; 10ml of 10%

19
Q

What drug should be considered in LA toxicity?

A

1.5 ml 20% intralipid

20
Q

Drug treatment for anaphylaxis?

A

IM adrenaline 500 mcg every 5 mins and IV crystalloid bolus
Chlorpheniramine 20mg IV
Hydrocortisone 200mg IV
Salbutamol neb

21
Q

Treatment for hypoglycemia?

A

If under 4 mmol/l give 50ml of 10% dextrose
OR
1mg glucagon IM

22
Q

DKA criteria?

A

Ketonaemia 3 mmol/l
BG > 11 mmol/l
Venous bicarb <15 mmol/l or venous pH <7.3

23
Q

Presentation of amniotic fluid embolism

A

Profound foetal distress
Sudden resp distress
Seizure
DIC

24
Q

What is the treatment of amniotic fluid embolism?

A

Supportive in ICU

25
Q

How can amniotic fluid embolism be confirmed?

A

Zine coproporphyrin levels increased

Post-mortem via squames on right side of circulation

26
Q

Investigations for massive PE?

A 
ECG; tachy, right side strain, S1Q3T3
CXR to exclude pneumothorax or pneumonia. May see wedge collapse
ABG; hypoxia 
Echo; rule out dissection and tamponade
Consider CTPA or V/Q scan
27
Q

Signs of a massive PE?

A

JVP raised
Enlarged liver
Parasternal heave
Fixed splitting of 2nd heart sound

28
Q

Ix for stroke

A 
Heat CT/ MRI
Echo
Coag
Thrombophilia screen
Carotid doppler
LP
Cerebral angiography
29
Q

What is cord prolapse associated with?

A

Malpresentation
Preterm labour
2nd twin
Artificial membrane rupture

30
Q

Why will cord prolapse lead to foetal death?

A

Direct compression and cord spasm resulting in decreased flow and hypoxia

31
Q

What are the ix for cord prolapse?

A

Scan for foetal cardiac activity

32
Q

What is the management for cord prolapse?

A

Immediate delivery; cat 1 (c/s or forceps)

Tocolytic and maternal position to relive pressure

33
Q

What is shoulder dystocia?

A

Any cephalic presentation where maneuvers other than gentle traction are required to delivery the baby after the head has delivered
Bony impaction of foetal anterior shoulder on maternal pubic symphysis

34
Q

What are risk factors for shoulder dystocia?

A 
Obesity
Diabetes
Macrosomia
Prolonged 1st or 2nd stage
Instrumental delivery
35
Q

What are the signs of shoulder dystocia?

A

Slow delivery of head
Turtling of head
Lack of restitution

36
Q

What is the head bobbing sign in terms of shoulder dystocia?

A

Head consistently retracts back between contractions during the active second stage

37
Q

What is the turtle sign in shoulder dystocia?

A

Delivered head becomes tightly pulled back against the perineum and there is difficulty delivering the chin

38
Q

What are the risks associated with shoulder dystocia?

A 
Stillbirth
Hypoxic brain injury
Brachial plexus injury
Fractures
PPH
3rd and 4th degree tears
39
Q

What reduces the risk of hypoxic ischaemic damage in shoulder dystocia?

A

If delivery is achieved within 5 mins from time of delivery of head

40
Q

What is the management of shoulder dystocia?

A 
HELPERR
Help
Evaluate for episiotomy
Legs (McRoberts manoeuvre) 
Pressure (suprapubic) 
Enter (rotational maneouvre)
Remove posterior arm 
Roll patient onto hands and knees
41
Q

What are the manouvres in shoulder dystocia designed to do?

A

Increase functional size of bony pelvis
Narrow bisacromial diameter of foetus
Change position of bisacromial diameter within bony pelvis

Repro and Sexual Health (77 decks)

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