Maternal mortality and medical problems during pregnancy Flashcards
Describe the major medical diseases contributing to maternal mortality
Direct (amniotic fluid embolism, hypertensive disorders, thrombosis, obstetric haemorrhage) vs Indirect (psych, cardiac)
- pregnancy only conditions: hypertensive disorders of pregnancy (preeclampsia/eclampsia), gestational diabetes, amniotic fluid embolus
- conditions exaccerbated by pregnancy (heart disease, pulmonary hypertension, renal failure are particulararly dangerous)
- puerpural sepsis
- post partum haemorrhage
- diabetes, epilepsy, thrombosis
Describe the physiological changes associated with normal pregnancy
- increase in cardiac out put, decrease in total peripheral resistance
- increase in blood volume. But relative/dilutional anaemia
- procoaguable state in third trimester (increase in clotting factors)
- weight gain
- laxity of joints eg pelvis
Understand how pregnancy impacts on women with pre-existing medical disease
-increased stress on system/pushed to limits of functional reserve
Understand the approach to prepregnancy counseling for a woman with cardiac disease
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Understand the approach to management of women with a past history of, or current, thromboembolism
-aspirin
Explain the principles of diagnostic imaging as applied to the pregnant mother
-where possible do imaging prior to becoming pregnant
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Explain the principles of how to perform effective resuscitation in a pregnant woman.
- tilt to left to avoid compression of vena cava by gravid uterus/reduction in venous return/cardiac output
- care with regurgitation/aspiration. Reduced lower oesophageal sphincter tone and increased intraabdominal pressure. Low threshold to entubate if needs GA
- priority is always mother
- account for increased blood volume/increased volume of distribution with resuscitation fluids and drugs (will leave vascular compartment more)
