Maternal Mortality Flashcards
What causes maternal death?
Preexisting condition: DM, Heart disease, psych
Post-partum haemorrhage
Preeclampsia
Sepsis
Direct maternal deaths
Amniotic fluid embolism
Post partum haemorrhage
Incidental death?
MVAs
Homocide
Cancer
Indirect death?
Cardiac death
H1N1
What cardiac changes in preg?
CO increases by 50% by 32w
TPR: decreases
What renal in preg changes?
GFR increases by 55%
GI changes in preg?
Progesterone: relaxes uterus, reduced esophageal sphincter, more GI motility
Haematologic all change in preg?
Anaemia of preg: dilution all due to increase volume, not as much as red cells.
Hypercoagulable state
Consideration in preg for resus?
Left tilt
Increase blood volume
Increase risk of aspiration: cuffed endotracheal
Make sure adequate ventiliation
Alpha/beta agonists may reduce utero placental perfusion
If preg mother arrests?
Defibrillation safe for fetus
Peri-mortem often C-section, decide at 4’, deliver at 5’
Contraindication for preg?
Pulmonary HT or eisenmenger’s syndrome
Risks of increased cardio output has implications for?
LV dysfunction: ischaemia, valvular, peri partum cardiomyopathy
Fixed output: (AS, MS)
Aneurysm
What can reduce diastolic filling time?
Tachycardia
Post partum cardio?
Get huge increase in preload, need good LV function
Worse cardiac lesions to have while preg?
Pulmonary HT
Cyanotic heart disease
NYHA III, IV
Prepare pre-preg Counselling of cardiac?
Determine lesion Assess NYHA Advise prog Consider if SBE prophylaces Consider anticoag
Risk of what post partum with cardiac disease?
Pulmonary oedema, give diuretics
Thromboembolism need to do what?
Prevention
Detection
Good Rx.
Thromboembolism cause/inter current risk factors?
Immobilized
Inadequate hydration
Where likely for preg woman to get DVT?
85% in left leg
PE
PE Ix?
VQ, CTPA
CXR
Anticoagulation choices in preg?
LMW heparin
Gestation sensitivities?
D0-D9 post conception
Resorption (>10 rads) or survive undamaged
W3-w11 post conception imaging?
no adverse fetal effect at
CXR fetal dose?
4Ms in DM1 for fetus?
Mortality
Macrosomia
Malformation
Miscarriage
Risks of obesity in mother for baby?
growth restrictions
Stillbirth risk
What to do when talking to woman of reproductive age?
ASK HER HER PLANS FOR PREGNANCY!
