maternal emergencies Flashcards
causes of maternal death
VTE = leading cause
sepsis deaths continuing to rise
cardiac disease = leading cause of death up to 6weeks after the end of pregnancy (rising rate from less deprived areas)
suicide -> 2 most commone direct cause of womens death during or up to 6wks after pregnancy
–> leading cause from 6wks to a year after pregnancy
why can left uterine displacement be useful in maternal collapse?
uterus can compress IVC + aorta
- IVC more significant - reduces cardiac output, leading to hypotension + if severe -> loss of cardiac output + cardiac arrest
hypotension because of this can precipitate collapse -> mx = left lateral position
(aortocaval compression)
principles of management of obstetric emergency
prevention
2 lives at stake - mum comes 1st
get help early - 2222/999
debreif for patient, partner, staff
early warning chart
5 Hs of maternal collapse
Head - eclampsia, epilepsy, CVA, vasovagal
Heart - MI, arrythmias, puerpartum cardiomyopathy
hypoxia - asthma, PE, pulmoary oedema, anaphylaxis
haemorrhage - abruption, atony, traume, ruptured aneurysm
wHole body + Hazards - hypoglycaemia, amniotic fluid, embolism, septicaemia, trauma, drug overdose, anaesthetic complications
4Hs + 4Ts of reversible causes of cardiac arrest
hypoxia
hypovolaemia - blood or sepsis
hypo/hypermetabolic - hyperkalamia
hypothermia
thromboembolism
tamponade
toxins
tension pneumothorax
2Cs of reversible causes of cardiac arrest in pregnancy
eClampsia
intraCerebral bleed
why can resuscitating a pregnant women difficult
gravida uterus
- aortocaval compression
- ventilation difficult - pressure on diaphragm
fetus/placenta
- “steals” oxygen + circulation from mother
- 20% decrease in pulmonary functional residual capacity + 20% increase in oxygen consumptions - more risk of hypoxia
more likely to aspirate
more difficult to intubate
no signs of life after 10seconds in pregnant wome
call 2222/999
keep woman supine with left uterine displacement
30 compressions - rate 100-120/min, depth 5-6cm
apply pads/monitor - attempt defib if appropriate
advance life support when anaethetist/resus team arrive
peri-mortem C-section
if no response to correct CPR within 4 mins of maternal collapse, delivery should be undertaken to assist maternal resus
- do at 5 mins, prepare at 4 mins
moving to operating theatre is not necessary
CPR should continue throughout
diathermy not needed as there is little blood loss - no cardiac output
if mother sucessfully resuscitated - can be moved to theatre to continue
what can be delivered after the 3rd shock of defibrillation
adrenaline 1mg after 3rd shock then every other cycle - every 4 mins
amiodarone 300mg after 3rd shock
specific drug treatment in maternal collapse
- Cardiac arrest – 1mg adrenaline every 2mins
- VF/VT – 300mg amiodarone
- Opiate overdose – 0.4-0.8mg naloxone
- Magnesium toxicity – 1g calcium gluconate
- Local anaesthetic toxicity – 1.5ml 20% intralipid
collapse due to eclampsia / seizure mx
- Call for help, make patient safe
- Note time + length of seizure
- Give high flow O2
- Don’t restrain patient during fit
- Get IV access -> magnesium sulphate
- Move patient into left lateral + open airway
- Monitor baby – only deliver when mum stabilised
collapse due to anaphylaxis mx
remove allergen
lie flat legs up
high flow o2
IM adrenaline 500mcg every 5 mins + IV crystalloid bolus
chlorphiniramine 20mg IV
hydrocortisone 200mg IV
salbutamol neb
management of hypoglycaemia in maternal collapse
glucose <3mmol/l -> 50ml 10% dextrose IV
or 1mg glucagon IM or glucogel
stop insulin
DKA diagnostic criteria
- ketonaemia 3mmol/l + over or significant ketonuria
- blood glucose over 11mmol/l or know diabetes mellitus
- HCO3 <15mmol/l or pH <7.3
**can be normoglycaemic in pregnancy
Mx - fluid replacement saline, insulin, treat causes, monitor ABG
- monitor baby - only deliver if mum stable
