Maternal Collapse in Pregnancy and the Puerperium - GT 56 Flashcards
What is the estimated rate of maternal collapse in the UK?
14-60/100,000 births
How frequent if major obstetric haemorrhage?
3.7/1000 maternities
What is the estimated frequency of amniotic fluid embolism?
And survival rate?
Between 1.25/100 000 and 12.5/100 000 maternities, with the most recent UK data giving an incidence of 2/100 000 maternities
Survival 80% 2010 but neurological morbidity recognised
What is the perinatal mortality rate of amniotic fluid embolism?
135/1000 total births
How does amniotic fluid embolism present?
Collapse during labour or delivery or within 30 mins
Acute hypotension, respiratory distress, acute hypoxia
May have seizures and cardiac arrest
Profound fetal distress if pre-delivery
What is the progression of amniotic fluid embolism?
May initially have pulmonary hypertension 2dry to vascular occlusion (debris/vasoconstriction)
Then LV dysfunction/failure
Coagulopathy followed by PPH if survives thus far
How is AFE diagnosed?
Clinically; no diagnostic tests premortem
What are the most common organisms implicated in obstetric sepsis?
Streptococcal groups A, B and D
Pneumococcus
Escherichia coli.
How does LA toxicity present?
Inebriation and lightheadedness
Sedation
Circumoral parasthesia and twitching
Severe:
Convulsions
Sudden LOC
Cardiovascular collapse - sinus brady, conduction blocks, asystole, ventricular tachyarrhythmias
What is the incidence and mortality of anaphylaxis?
Incidence - 3-10/1000
Mortality rate 1%
What can be useful in diagnosing anaphylaxis?
Mast cell tryptase levels
What is the ratio of cardiac compressions:breaths in CPR?
30:2
What is the rate of cardiac compressions in CPR?
100/min
What is the rate of ventilation breaths in CPR?
10/min
When should perimortem caesarean section be performed?
If CPR not effective within 4mins of collapse and beyond 20/40
Delivery achieved within 5 minutes
When can irreversible brain damage ensue in the pregnant woman?
4-6mins
Which instruments should be included on a perimortem CS tray?
Fixed blade scalpel
2 clamps for the cord
What should be the initial fluid resuscitation in sepsis?
20ml/kg crystalloid/colloi
Then to maintain MAP > 65mmHg
CVP >8mmHg (or 12 if ventilated)
What is the antidote to MgSO4 toxicity?
10ml 10% Calcium gluconate IV given over 10 mins
What is the treatment for cardiac arrest 2dry to LA toxicity?
20% intralipid 1.5ml/kg over 1 min
Then infusion of 0.25ml/kg/min
Bolus can be repeated twice after 5 mins if insufficient circulation
What is the treatment for anaphylaxis after removing the source?
0.5ml of 1:1000 adrenaline IM
In experienced hands - 0.5ml 1:10,000 IV
Followed by 10mg chlorampheniramine and 200mg hydrocortisone IM or slow IV
