Maternal Resus

Question 1

Define

Answer 1

RCOG (2011) an acute event involving the brain and cardio-respiratory systems resulting in reduced or absent consciousness (potentially leading to death) at any stage of pregnancy and up to 6 weeks postnatally.

Question 2

Incidence rate

Answer 2

8.8 per 100,000 mat death due to collapse.

Maternal collapse 0.14-0.6 per 1000 births.

Question 3

Risk factors

Answer 3

Cardiovascular issues, embolism, seizure, sepsis, cerebrovascular issues, haemorrhage, drug toxicity/ anaphylaxis, anaesthetic complications, metabolic disorders (often related to diabetes e.g. DKA or hypoglycaemia)

Question 4

5 types of shock

Answer 4

Cardiovascular > failure of the heart to pump properly
Hypovolaemic > loss of blood or fluid volume e.g. APH, PPH.
Obstructive> P/E, amniotic fluid embolism.
Neurogenic > Problem with the vessels resulting from loss of balance between parasympathetic and sympathetic nervous systems.
Distributive > Occurs with anaphylaxis/sepsis

Question 5

What happens in shock?

Answer 5

BP drops, Not enough o2 perfusion, cellular dysfunction, Anaerobic respiration, Lactate increases, pH lowers, SIRS occurs, Global dysfunction leading to MODS. Lactate levels.

Question 6

Initial management

Answer 6

Initial management same regardless of cause.

ABCDE assess, treat and stabilise.

Question 7

History?

Answer 7

? drugs. ? medical illness. ? allergy. ? diabetic. ?substance misuse. ? srom. ? infection.

Question 8

ABCDE

Answer 8

“are you alright?” in both ears. Shake shoulders
Airway- lie flat on back, head tilted back, chin lifted. Any obstructions? Manually displace uterus to the left with help of a second person. Head tilt, chin lift.
Breathing- Chest rise? ear to mouth to feel breath (not agonal) no more than 10 seconds. If unsure or breathing absent, commence CPR.
Circulation- CPR. Lean directly over, hands in CPR position over sternum. Depress centre of chest by 5-6 cm. 100-120 per minute. Discuss recoil.
Rescue breaths 30 compressions to 2 breaths, Use bag - valve- mask. (ensure correct size mask). No chest rise? Jaw thrust or OP airway (upside down and rotate halfway)

Question 9

What bloods for Maternal Resus?

Answer 9

Take bloods when gaining IV access.
Bloods will vary depending suspected cause.
- FBC(PLT (DIC),Hb, WBC ^/(infection)
- Group & Save > crossmatch (PPH/APH 4/6units/ FFP)
- Us&Es & LFTs (liver & kidney ^ Creatinine poor kidney function. ^ ALTs liver damage.
- Clotting (DIC)
- CRP (quick infection marker)
- Lactate >1mmol monitor, fluid 30ml/kg. >2mmol urgent review, fluid 30ml/kg. >4 mmol urgent cons r/v & crit care team.
- Capillary glucose (hyperglycaemia for infection)
- Blood gas> acidotic

Question 10

Fluids?

Answer 10

Hartmanns 1 litre increase circulating volume and restore perfusion. (CAUTION IF ?ECLAMPSIA)

Question 11

Further interventions?

Answer 11

Defibrillation.
Further drugs> Adrenaline 1g IV every 3-5 mins to raise blood pressure. Amiodarone 300mg after 3 shocks to treat arrhythmia. If no improvement move to perimortem section to aid resus.

Question 12

Follow up?

Answer 12

Normal PN care on labour ward 1:1. Monitor PV loss, Pain relief, BFS, VTE adjusted. ?ITU/HDU SCBU?/ Hypo pathway.
Document, DATIX, Debrief. After action r/v